Healthcare Provider Details

I. General information

NPI: 1093392243
Provider Name (Legal Business Name): RONALD S LEDERMAN, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31500 TELEGRAPH RD STE 235
BINGHAM FARMS MI
48025-4315
US

IV. Provider business mailing address

2300 HAGGERTY RD STE 1110
WEST BLOOMFIELD MI
48323-2185
US

V. Phone/Fax

Practice location:
  • Phone: 248-669-2000
  • Fax: 248-669-2110
Mailing address:
  • Phone: 248-669-2000
  • Fax: 248-669-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RONALD S LEDERMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 248-669-2000