1174637995 NPI number — DR. MARK E LEVENTER MD

Table of content: DR. MARK E LEVENTER MD (NPI 1174637995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174637995 NPI number — DR. MARK E LEVENTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVENTER
Provider First Name:
MARK
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174637995
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRASS LAKE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49240-0246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-522-8403
Provider Business Mailing Address Fax Number:
517-522-4275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12337 E MICHIGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRASS LAKE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49240-0246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-522-8403
Provider Business Practice Location Address Fax Number:
517-522-4275
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ML041377 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0803800311 . This is a "BCBS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0803800311 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2126585 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 383042885 . This is a "CIGNA CONNECTICUT GENERAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383042885 . This is a "CIGNA CONNECTICUT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0803800311 . This is a "BCBS COMMUNITY BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0803800311 . This is a "BLUE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0803800311 . This is a "BCBS BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0803800311 . This is a "BCBS BLUE PREFERRED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0803800311 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 383042885 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383042885 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383042885 . This is a "CONSECO HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383042885 . This is a "CORESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383042885 . This is a "CONTINENTAL LIFE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383042885 . This is a "CONTINENTAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0803800311 . This is a "BCBS FEP PROGRAM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 383042885 . This is a "CONSECO" identifier . This identifiers is of the category "OTHER".




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