Provider Demographics
NPI:1649026188
Name:TAKEM, LEVIROY
Entity type:Individual
Prefix:
First Name:LEVIROY
Middle Name:
Last Name:TAKEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 MANTON WAY
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2489
Mailing Address - Country:US
Mailing Address - Phone:240-260-8338
Mailing Address - Fax:
Practice Address - Street 1:6612 MANTON WAY
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2489
Practice Address - Country:US
Practice Address - Phone:240-260-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator