Provider Demographics
NPI:1952438780
Name:FARREL F LEVASSEUR PC
Entity Type:Organization
Organization Name:FARREL F LEVASSEUR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FARREL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:LEVASSEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-893-3579
Mailing Address - Street 1:916 WASHINGTON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5730
Mailing Address - Country:US
Mailing Address - Phone:989-893-3579
Mailing Address - Fax:
Practice Address - Street 1:916 WASHINGTON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5730
Practice Address - Country:US
Practice Address - Phone:989-893-3579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIFL0070971223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9750961480OtherBCN - MICHIGAN
MI9702911950OtherBCBS GROUP
MI9750961480OtherBCBSM
MI9750961480OtherBCN - MICHIGAN
MIFL07097Medicare UPIN