1427264928 NPI number — DR. CURTIS A. LEVANG PH.D.

Table of content: DR. CURTIS A. LEVANG PH.D. (NPI 1427264928)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427264928 NPI number — DR. CURTIS A. LEVANG PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVANG
Provider First Name:
CURTIS
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1427264928
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4010 BAYSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MAPLE PLAIN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55359-9619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-541-4799
Provider Business Mailing Address Fax Number:
952-541-4831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8441 WAYZATA BLVD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
GOLDEN VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-541-4799
Provider Business Practice Location Address Fax Number:
763-231-4445
Provider Enumeration Date:
05/14/2007

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: 103TC0700X , with the licence number:  LP1408 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 0235 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 68786LE . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 763350500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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