Organization
JEFFREY LEIDER MD PLLC
Active
Other names
OnHealthcare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY LEIDER MD (CLINICAL DIRECTOR)
(248) 528-1981
Entity
Organization
Contact information
Practice address
35 AUGUSTA AVE, FT WRIGHT, KY 41011-3603
(248) 528-1981
(248) 528-2963
Mailing address
1200 KIRTS BLVD, SUITE 200, TROY, MI 48084-4899
(248) 528-1981
(248) 528-2963
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100198660
—
KY
Enumeration date
03/27/2012
Last updated
03/03/2022
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