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Organization
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Active
Organization
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Active
Parent organization
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Other names
Advanced Dermatology and Cosmetic Surgery
Organization subpart
Yes
Provider details
NPI number
Legal business name
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Authorized official
AMY DECLUE (DIRECTOR, PROVIDER SERVICES)
(407) 875-2080
Entity
Organization
Contact information
Practice address
1920 DON WICKHAM DR, SUITE 330, CLERMONT, FL 34711-1918
(352) 241-4298
(352) 241-7620
Mailing address
2600 LAKE LUCIEN DR STE 180, MAITLAND, FL 32751-7235
(407) 875-2080
(407) 875-0518
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
NULL
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
NULL
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
NULL
207NP0225X
Pediatric Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
208200000X
Plastic Surgery Physician
—
NULL
208200000X
Plastic Surgery Physician
—
—
Other
Enumeration date
05/30/2008
Last updated
08/25/2010
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