Provider Demographics
NPI:1982696209
Name:LEVEILLE, DENNIS W (DPM)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:LEVEILLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:126 S 25TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-1364
Mailing Address - Country:US
Mailing Address - Phone:906-786-2385
Mailing Address - Fax:906-789-4445
Practice Address - Street 1:126 S 25TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1364
Practice Address - Country:US
Practice Address - Phone:906-786-2385
Practice Address - Fax:906-789-4445
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001228213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4729159Medicaid
WI43228100Medicaid
WI43228100Medicaid
MI4729159Medicaid