Individual
MITCHELL HUGH LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215-4330
(414) 649-6588
(770) 237-1723
Mailing address
8001 RIDGES RD, BAILEYS HARBOR, WI 54202-9362
(941) 204-9149
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25639
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
009
BCBS
WI
05
—
30556800
—
WI
Enumeration date
10/03/2005
Last updated
06/06/2008
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