MEDICARE: LESLIE G LAFER, DOPLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1558859579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESLIE G LAFER, DOPLLC

Provider Business Mailing Address
First Line	:	1437 E 12 MILE ROAD
Second Line	:	BUILDING D
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071
Country	:	US
Telephone Number	:	248-948-9508
Fax Number	:	248-948-9158

Provider Business Practice Location Address
First Line	:	1437 E 12 MILE ROAD
Second Line	:	BUILDING D
City	:	MADISON HEIGHTS
State	:	MI
Zip	:	48071
Country	:	US
Telephone Number	:	248-948-9508
Fax Number	:	248-948-9158

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KATHLEEN STONIK
Credential	:
Telephone Number	:	248-948-9508

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	04/25/2018

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