Provider Demographics
NPI:1962487256
Name:LEVENHAGEN, TIM CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:CHRISTOPHER
Last Name:LEVENHAGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34700 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4500
Mailing Address - Country:US
Mailing Address - Phone:800-767-4411
Mailing Address - Fax:262-646-7067
Practice Address - Street 1:34700 VALLEY RD
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4500
Practice Address - Country:US
Practice Address - Phone:800-767-4411
Practice Address - Fax:262-646-7067
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI333980202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32189000Medicaid
WI32189000Medicaid
WI68683Medicare ID - Type Unspecified