Organization
LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Active
Other names
Advanced Dermatology And Cosmetic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
AMY DECLUE (DIRECTOR OF PROVIDER SERVICES)
(407) 875-2080
Entity
Organization
Contact information
Practice address
120 INTERNATIONAL PKWY, 240, HEATHROW, FL 32746-5031
(407) 333-4200
(407) 829-6637
Mailing address
151 SOUTHHALL LN, STE 300, MAITLAND, FL 32751-7233
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
OS5365
FL
207ND0101X
MOHS-Micrographic Surgery Physician
OS5365
FL
207ND0900X
Dermatopathology Physician
OS5365
FL
207NP0225X
Pediatric Dermatology Physician
OS5365
FL
207NS0135X
Procedural Dermatology Physician
OS5365
FL
207Q00000X
Family Medicine Physician
OS5365
FL
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
OS5365
FL
208200000X
Plastic Surgery Physician
OS5365
FL
208600000X
Surgery Physician
OS5365
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256877200
—
FL
Enumeration date
07/02/2006
Last updated
08/29/2017
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