Provider Demographics
NPI:1154173581
Name:LEVESQUE, ADAM C (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:C
Last Name:LEVESQUE
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:7747 BENECIA DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-7287
Mailing Address - Country:US
Mailing Address - Phone:508-328-8860
Mailing Address - Fax:
Practice Address - Street 1:FORT CARSON
Practice Address - Street 2:DIRAIMONDO FAMILY CLINIC
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-524-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant