MEDICARE: JEFFREY S. LEIDER, MD,PC

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	174400000X	Specialist	4301053044	MI

General Provider Information

NPI Number	:	1467527507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY S. LEIDER, MD,PC

Provider Business Mailing Address
First Line	:	24001 ORCHARD LAKE RD
Second Line	:	SUITE 170
City	:	FARMINGTON
State	:	MI
Zip	:	48336-2555
Country	:	US
Telephone Number	:	248-615-4368
Fax Number	:	248-615-4342

Provider Business Practice Location Address
First Line	:	24001 ORCHARD LAKE RD
Second Line	:	SUITE 170
City	:	FARMINGTON
State	:	MI
Zip	:	48336-2555
Country	:	US
Telephone Number	:	248-615-4368
Fax Number	:	248-615-4342

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JEFFREY S LEDIER
Credential	:	MD
Telephone Number	:	248-615-4368

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	08/22/2020

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