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35 Augusta Ave Ft Wright KY 41011-3603 | |
(248) 528-1981 | |
(248) 528-2963 |
Full Name | |
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Speciality | Family Medicine - Geriatric Medicine |
Location | 35 Augusta Ave, Ft Wright, Kentucky |
Authorized Official Name and Position | Jeffrey Leider (CLINICAL DIRECTOR) |
Authorized Official Contact | 2485281981 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1200 Kirts Blvd Suite 200 Troy MI 48084-4899 Ph: (248) 528-1981 | 35 Augusta Ave Ft Wright KY 41011-3603 Ph: (248) 528-1981 |
NPI Number | 1063788818 |
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Provider Enumeration Date | 03/27/2012 |
Last Update Date | 03/03/2022 |
Identifier | Type | State | Issuer |
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1063788818 | NPI | - | NPPES |
7100198660 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
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207QG0300X | Family Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |