Individual
DR. MARK E LEVENTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12337 E MICHIGAN AVE, GRASS LAKE, MI 49240-0246
(517) 522-8403
(517) 522-4275
Mailing address
PO BOX 246, GRASS LAKE, MI 49240-0246
(517) 522-8403
(517) 522-4275
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ML041377
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0803800311
BCBS
MI
01
—
0803800311
BCBS PPO
—
05
—
2126585
—
MI
01
—
383042885
CIGNA CONNECTICUT GENERAL
—
Enumeration date
08/18/2006
Last updated
12/23/2020
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