Provider Demographics
NPI:1629545645
Name:ANDRE YUAN LEVESQUE, MD PLLC
Entity Type:Organization
Organization Name:ANDRE YUAN LEVESQUE, MD PLLC
Other - Org Name:LEVESQUE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:YUAN
Authorized Official - Last Name:LEVESQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-487-5975
Mailing Address - Street 1:11851 JOLLYVILLE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-2350
Mailing Address - Country:US
Mailing Address - Phone:512-487-5975
Mailing Address - Fax:737-931-1976
Practice Address - Street 1:11851 JOLLYVILLE RD STE 203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-2350
Practice Address - Country:US
Practice Address - Phone:512-487-5975
Practice Address - Fax:737-931-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3977118Medicaid