Provider Demographics
NPI:1619185238
Name:LEDBETTER, ANGELA LATICE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:LATICE
Last Name:LEDBETTER
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Gender:F
Credentials:MD
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Mailing Address - Street 1:22101 MOROSS RD
Mailing Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2148
Mailing Address - Country:US
Mailing Address - Phone:313-343-8797
Mailing Address - Fax:313-343-7620
Practice Address - Street 1:22101 MOROSS RD
Practice Address - Street 2:DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2148
Practice Address - Country:US
Practice Address - Phone:313-343-8797
Practice Address - Fax:313-343-7620
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301086803207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine