Provider Demographics
NPI:1568722676
Name:LEVIKER, CHARLES WALTER (MS)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WALTER
Last Name:LEVIKER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7135 STATE ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-2829
Mailing Address - Country:US
Mailing Address - Phone:315-783-3091
Mailing Address - Fax:
Practice Address - Street 1:7135 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-2829
Practice Address - Country:US
Practice Address - Phone:315-783-3091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator