Basic Information
Provider Information
NPI: 1124140405
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEVASHKEVICH
FirstName: ALEXEY
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 S BALLENGER HWY
Address2:  
City: FLINT
State: MI
PostalCode: 485323638
CountryCode: US
TelephoneNumber: 8103421000
FaxNumber: 8103421590
Practice Location
Address1: 1010 N LINDEN RD
Address2:  
City: FLINT
State: MI
PostalCode: 485322339
CountryCode: US
TelephoneNumber: 8107323660
FaxNumber: 8107321082
Other Information
ProviderEnumerationDate: 04/06/2007
LastUpdateDate: 11/29/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VX0000X4301089261MIY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics

No ID Information.


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