Provider Demographics
NPI:1609855253
Name:LEDERMAN, RONALD S (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:S
Last Name:LEDERMAN
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:PO BOX 74008434
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-8434
Mailing Address - Country:US
Mailing Address - Phone:248-669-2000
Mailing Address - Fax:248-669-2110
Practice Address - Street 1:2300 HAGGERTY RD
Practice Address - Street 2:SUITE 1110
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48323-2184
Practice Address - Country:US
Practice Address - Phone:248-669-2000
Practice Address - Fax:248-669-2110
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRL064514207X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00215896OtherMEDICARE RAILROAD
F72414OtherHAP
MI0F33953OtherBCBS
203208200OtherWORK COMP
129392OtherCARE CHOICES
MI0N95120Medicare PIN
203208200OtherWORK COMP