Provider Demographics
NPI:1669497327
Name:LEFF, RANDY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:MICHAEL
Last Name:LEFF
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-355-4000
Mailing Address - Fax:248-355-4047
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-355-4000
Practice Address - Fax:248-355-4047
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIRL002077213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000246823101OtherUNITED HEALTH CARE
141874OtherCARE CHOICES
7833658OtherAETNA
146963OtherGREAT LAKES HEALTH PLAN
RL002077OtherBLUE CROSS BLUE SHIELD
MI4741574Medicaid
73171OtherMCARE
146963OtherGREAT LAKES HEALTH PLAN