Provider Demographics
NPI:1528091378
Name:LEFF, FRED BARRY (DPM)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:BARRY
Last Name:LEFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:29201 TELEGRAPH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1331
Mailing Address - Country:US
Mailing Address - Phone:248-355-4000
Mailing Address - Fax:248-355-4047
Practice Address - Street 1:29201 TELEGRAPH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1331
Practice Address - Country:US
Practice Address - Phone:248-355-4000
Practice Address - Fax:248-355-4047
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIFL000635213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1084800Medicaid
121304OtherCARE CHOICES
197722OtherTOTAL HEALTH CARE
M007964-0000OtherTRICARE
MCAREOtherC3270
101775OtherGREAT LAKES HEALTH PLAN
0000159101501OtherUNITED HEALTH CARE
22518OtherOMNICARE
MI791480566OtherRAILROAD MEDICARE
MI5447570001OtherADMINISTAR
M007964-0000OtherTRICARE
MI791480566OtherRAILROAD MEDICARE