Provider Demographics
NPI:1841395183
Name:LEVITSKY, DAVID RANDOLPH (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDOLPH
Last Name:LEVITSKY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 0
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MI
Mailing Address - Zip Code:49236-9502
Mailing Address - Country:US
Mailing Address - Phone:517-456-4114
Mailing Address - Fax:517-456-4114
Practice Address - Street 1:1671 W MICHIGAN AVE
Practice Address - Street 2:STE C-1
Practice Address - City:CLINTON
Practice Address - State:MI
Practice Address - Zip Code:49236-8702
Practice Address - Country:US
Practice Address - Phone:517-456-4114
Practice Address - Fax:517-456-4114
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000792213E00000X
NV0504213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5067480002OtherDMERC
T34218Medicare UPIN
8465571Medicare ID - Type Unspecified