Provider Demographics
NPI:1548259641
Name:LEIDER, JEFFREY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:LEIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24001 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:FARMINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2555
Mailing Address - Country:US
Mailing Address - Phone:248-615-4368
Mailing Address - Fax:248-615-4342
Practice Address - Street 1:24001 ORCHARD LAKE RD
Practice Address - Street 2:SUITE 170
Practice Address - City:FARMINGTON
Practice Address - State:MI
Practice Address - Zip Code:48336-2555
Practice Address - Country:US
Practice Address - Phone:248-615-4368
Practice Address - Fax:248-615-4342
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053044207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0635702Medicare ID - Type Unspecified
F51824Medicare UPIN