Provider Demographics
NPI:1740356914
Name:LEVITT, JEFFERY (DPM)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:
Last Name:LEVITT
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 1:3406 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1958
Mailing Address - Country:US
Mailing Address - Phone:248-342-0653
Mailing Address - Fax:
Practice Address - Street 1:3406 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-1958
Practice Address - Country:US
Practice Address - Phone:248-342-0653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400153213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI131816072Medicaid
MI5631370OtherBCBSM
MIT34194Medicare UPIN
MI131816072Medicaid
MIMI5282Medicare PIN