Provider Demographics
NPI:1396850459
Name:LEDTKE, STEVEN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALAN
Last Name:LEDTKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:875 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48040-1404
Mailing Address - Country:US
Mailing Address - Phone:810-364-8600
Mailing Address - Fax:810-364-4346
Practice Address - Street 1:875 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:MI
Practice Address - Zip Code:48040-1404
Practice Address - Country:US
Practice Address - Phone:810-364-8600
Practice Address - Fax:810-364-4346
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1646876Medicaid
MI1646876Medicaid
MI07410319082Medicare ID - Type Unspecified
MI0N71040029Medicare PIN