# LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- **Other names:** Advanced Dermatology and Cosmetic Surgery
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1144488628
- **Legal business name:** LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- **Authorized official:** AMY DECLUE (DIRECTOR, PROVIDER SERVICES)
- **Authorized official phone:** (407) 875-2080

## Contact information

- **Practice address:** 1920 DON WICKHAM DR, SUITE 330, CLERMONT, FL 34711-1918
- **Practice address phone:** (352) 241-4298
- **Practice address fax:** (352) 241-7620
- **Mailing address:** 2600 LAKE LUCIEN DR STE 180, MAITLAND, FL 32751-7235
- **Mailing address phone:** (407) 875-2080
- **Mailing address fax:** (407) 875-0518

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207N00000X | Dermatology Physician | — | NULL | Yes |
| 207N00000X | Dermatology Physician | — | — | Yes |
| 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