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
540 MEDICAL OAKS AVE, SUITE 102, BRANDON, FL 33511-5961
(813) 651-1991
(813) 651-1401
Mailing address
151 SOUTHHALL LN, STE 300, MAITLAND, FL 32751-7176
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
208200000X
Plastic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
256877202
—
FL
Enumeration date
05/30/2008
Last updated
12/04/2014
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