Provider Demographics
NPI:1174312748
Name:LIDSKY, HARTLEE GRACE JOHNSTON (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:HARTLEE
Middle Name:GRACE JOHNSTON
Last Name:LIDSKY
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:HARTLEE
Other - Middle Name:GRACE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 E MEDICAL CENTER DR.
Mailing Address - Street 2:3116 TC, SPC 5368
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109
Mailing Address - Country:US
Mailing Address - Phone:734-998-2020
Mailing Address - Fax:
Practice Address - Street 1:1051 N CANTON CENTER RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-5097
Practice Address - Country:US
Practice Address - Phone:734-844-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351054061390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program