Basic Information
Provider Information
NPI: 1346738218
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEVIT
FirstName: KELVY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 901 RANCHO LN STE 135
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891063826
CountryCode: US
TelephoneNumber: 7023837885
FaxNumber: 7023838235
Practice Location
Address1: 901 RANCHO LN STE 135
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891063826
CountryCode: US
TelephoneNumber: 7023837885
FaxNumber: 7023838235
Other Information
ProviderEnumerationDate: 04/26/2018
LastUpdateDate: 08/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XDO2901NVY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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