Healthcare Provider Details

I. General information

NPI: 1407854482
Provider Name (Legal Business Name): MICHAEL THOMAS LEDET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 US HIGHWAY 90 STE 102
DAPHNE AL
36526-9510
US

IV. Provider business mailing address

7101 US HIGHWAY 90 STE 102
DAPHNE AL
36526-9510
US

V. Phone/Fax

Practice location:
  • Phone: 251-278-6022
  • Fax: 251-278-3930
Mailing address:
  • Phone: 251-278-6022
  • Fax: 251-278-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number12669
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: