Leavitt Medical Associates of Florida Inc
Organization Active NPI Dermatology Physician · Orlando, FL
NPI 1427216985 · NPPES record last updated Apr 21, 2010
Key facts
- NPI
- 1427216985
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
- Practice address
- 2868 S Alafaya TRL Ste 130
Orlando, FL 32828-7974 - Phone
- (407) 770-0063
- Fax
- (407) 770-0129
- NPI assigned
- May 30, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC
Authorized official
- Name
- Amy Declue
- Title
- Director, Provider Services
- Phone
- (407) 875-2080
Corporate family (same tax ID) 22
Practitioners 4
-
Lisa Hair, PA
-
Douglas Re, P.A.
-
Jayson Travis Keener, PA-C
-
Sonya Unnoppet, PA
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2058108 | Advanced Dermatology and Cosmetic Surgery | Certificate of waiver | Sep 17, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050228000737 | FL | Part B Supplier - Clinic/Group Practice | 4688579311 |
Receives reassigned benefits from 243 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Leavitt Medical Associates of Florida Inc
- Part of
- Leavitt Medical Associates of Florida Inc
Locations
2868 S Alafaya Trl
Ste 130
Orlando, FL 32828
Phone (407) 770-0063
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| Family Medicine Physician |
207Q00000X | |||
| Plastic Surgery Physician |
208200000X |
Addresses
Primary practice location
2868 S Alafaya TRL Ste 130
Orlando, FL 32828-7974
Mailing address
2600 Lake Lucien Dr Ste 180
Maitland, FL 32751-7235
Phone (407) 875-2080
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 256877222 | Medicaid | FL |
Other names
- Advanced Dermatology and Cosmetic Surgery
Other providers in Orlando, FL
- Jessica Leather
- Lina Esmeraldo Leavens
- Leavitt Medical Associates of Florida Inc
- Leavitt Medical Associates of Florida Inc
- Leavitt Medical Associates of Florida Inc
- Anna Leavitt
- Debra Anne Leavitt
- Jeannie Rosch Leavitt
- Karla M Leavitt
- Christopher A Leblanc
All providers in Orlando, FL · Dermatology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 21, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.