Healthcare Provider Details

I. General information

NPI: 1407811938
Provider Name (Legal Business Name): DAVID D LEDINGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W MITCHELL ST SUITE 140
PETOSKEY MI
49770-2275
US

IV. Provider business mailing address

560 W MITCHELL ST SUITE 140
PETOSKEY MI
49770-2275
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-1900
  • Fax: 231-487-2707
Mailing address:
  • Phone: 231-487-1900
  • Fax: 231-487-2707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301034121
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: