Provider Demographics
NPI:1467527507
Name:JEFFREY S. LEIDER, MD,PC
Entity Type:Organization
Organization Name:JEFFREY S. LEIDER, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEDIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-615-4368
Mailing Address - Street 1:24001 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2555
Mailing Address - Country:US
Mailing Address - Phone:248-615-4368
Mailing Address - Fax:248-615-4342
Practice Address - Street 1:24001 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-2555
Practice Address - Country:US
Practice Address - Phone:248-615-4368
Practice Address - Fax:248-615-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty