Provider Demographics
NPI:1407854482
Name:LEDET, MICHAEL THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:THOMAS
Last Name:LEDET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 US HIGHWAY 90 STE 102
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-9510
Mailing Address - Country:US
Mailing Address - Phone:251-278-6022
Mailing Address - Fax:251-278-3930
Practice Address - Street 1:7101 US HIGHWAY 90 STE 102
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-9510
Practice Address - Country:US
Practice Address - Phone:251-278-6022
Practice Address - Fax:251-278-3930
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12669207QS1201X
AL00012669207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51543412OtherBC
AL51119502OtherBC
AL1198407OtherUNITED HEALTHCARE
AL009902075Medicaid
AL51119502OtherBC
AL009902075Medicaid