Individual
KENNETH M LEAVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
125 PARKER HILL AVE, STE 390, BOSTON, MA 02120-2847
(617) 277-3800
(617) 277-3808
Mailing address
67 MILLBROOK ST., C/O CHM, WORCESTER, MA 01606-2835
(508) 795-0009
(508) 795-0393
Taxonomy
Speciality
Code
Description
License number
State
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
1680
MA
213E00000X
Podiatrist
Primary
1680
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
350273
—
MA
Enumeration date
06/29/2006
Last updated
03/02/2015
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