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NPI Code Detail

MEDICARE: MARCIALEE LEDBETTER MD

MEDICARE: MARCIALEE LEDBETTER MD
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
12084P0804XChild & Adolescent Psychiatry Physician036084346IL
22084P0800XPsychiatry Physician20207OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164492567
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCIALEE LEDBETTER MD
Provider Business Mailing Address
First Line : 5148 N ASHLAND AVE # 1
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2830
Country : US
Telephone Number : 918-995-0584
Fax Number : 918-660-3631
Provider Business Practice Location Address
First Line : 25 JUNE ST
Second Line :
City : SANFORD
State : ME
Zip : 04073-2621
Country : US
Telephone Number : 207-324-4310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2006
Last Update Date : 10/24/2022

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Directions to “ MARCIALEE LEDBETTER MD” Practice Location

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