Basic Information
| Provider Information | |||||||||
| NPI: | 1770833089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAVITT | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 S VOSS RD # 110-515 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770571086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139325757 | ||||||||
| FaxNumber: | 7139325750 | ||||||||
| Practice Location | |||||||||
| Address1: | 23900 KATY FWY | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774941323 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816447000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2012 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | P5406 | TX | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.