Provider Demographics
NPI:1790703411
Name:LEVISETTI, MATTEO G (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTEO
Middle Name:G
Last Name:LEVISETTI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8127
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-3500
Mailing Address - Fax:314-362-4096
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:5TH FLOOR, SUITE C
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-362-3500
Practice Address - Fax:314-362-4096
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2009-01-28
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Provider Licenses
StateLicense IDTaxonomies
MO2004004246207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209101500Medicaid
MO209101500Medicaid
IL$$$$$$$$$Medicaid
P00145932Medicare PIN
917640183Medicare PIN