MEDICARE: DR. KRISTI J LEDBETTER DPM

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	213E00000X	Podiatrist	KL002092	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00739357	OTHER	MI	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	114527	OTHER	MI	AETNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	36740	OTHER	MI	HEALTH PLAN OF MICHIGAN
4	48-5-81-1491-0	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1710959127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTI J LEDBETTER DPM

Provider Business Mailing Address
First Line	:	2797 SPRING ARBOR RD
Second Line	:	STE. A
City	:	JACKSON
State	:	MI
Zip	:	49203-3605
Country	:	US
Telephone Number	:	517-784-0900
Fax Number	:	517-784-7835

Provider Business Practice Location Address
First Line	:	2797 SPRING ARBOR RD
Second Line	:	STE. A
City	:	JACKSON
State	:	MI
Zip	:	49203-3605
Country	:	US
Telephone Number	:	517-784-0900
Fax Number	:	517-784-7835

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	01/14/2021

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Directions to “ DR. KRISTI J LEDBETTER DPM” Practice Location

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