Basic Information
Provider Information
NPI: 1770773244
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEVASHKEVICH
FirstName: ZHANNA
MiddleName: LEONIDOVNA
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3207 PINEHURST LN
Address2:  
City: GRAND BLANC
State: MI
PostalCode: 484392606
CountryCode: US
TelephoneNumber: 8106060520
FaxNumber: 8106060520
Practice Location
Address1: 1 HURLEY PLZ
Address2:  
City: FLINT
State: MI
PostalCode: 485035902
CountryCode: US
TelephoneNumber: 8102579000
FaxNumber: 8102579000
Other Information
ProviderEnumerationDate: 07/31/2007
LastUpdateDate: 07/31/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X4301087842MIY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home