Provider Demographics
NPI:1386176980
Name:LEAVITT, WILLIAM III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:LEAVITT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TRIPP
Other - Middle Name:
Other - Last Name:LEAVITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:DERMATOLOGY & PLASTIC SURGERY INSTITUTE
Mailing Address - Street 2:9500 EUCLID AVE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3820
Practice Address - Country:US
Practice Address - Phone:216-894-9483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH57.030452390200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program