Provider Demographics
NPI:1366408536
Name:LEVITSKI-HEIKKILA, TERESA VERONICA (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:VERONICA
Last Name:LEVITSKI-HEIKKILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:VERONICA
Other - Last Name:LEVITSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2735
Mailing Address - Country:US
Mailing Address - Phone:320-240-2206
Mailing Address - Fax:320-240-2108
Practice Address - Street 1:1200 6TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2735
Practice Address - Country:US
Practice Address - Phone:320-240-2206
Practice Address - Fax:320-240-2108
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9197207R00000X, 207RN0300X
MN50051207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12039Medicaid
MN514133800Medicaid
ND12039Medicaid
MN514133800Medicaid