Provider Demographics
NPI:1629273214
Name:LEVACK, MELISSA M (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:LEVACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 MORNING STAR WAY
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-9065
Mailing Address - Country:US
Mailing Address - Phone:404-617-9579
Mailing Address - Fax:
Practice Address - Street 1:2122 MANCHESTER EXPY
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6878
Practice Address - Country:US
Practice Address - Phone:303-744-1065
Practice Address - Fax:303-733-1699
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0071563208600000X, 208G00000X
MAL-231921208600000X
UT14226449-1235208G00000X
MIEMC0007326208G00000X
TN56241208G00000X
GA105549208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery