1184767238 NPI number — DANIEL ALAN LADIZINSKY M.D.

Table of content: DANIEL ALAN LADIZINSKY M.D. (NPI 1184767238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184767238 NPI number — DANIEL ALAN LADIZINSKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LADIZINSKY
Provider First Name:
DANIEL
Provider Middle Name:
ALAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LADIN
Provider Other First Name:
DANIEL
Provider Other Middle Name:
ALAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184767238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9900 SE SUNNYSIDE RD
Provider Second Line Business Mailing Address:
KAISER PERMANENTE SUNNYBROOK MEDICAL OFFICE
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015-9777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-571-3162
Provider Business Mailing Address Fax Number:
503-571-3069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9900 SE SUNNYSIDE RD
Provider Second Line Business Practice Location Address:
KASIER PERMANENTE SUNNYBROOK MEDICAL OFFICE
Provider Business Practice Location Address City Name:
CLACKAMAS
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97015-9777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-571-3162
Provider Business Practice Location Address Fax Number:
503-571-3069
Provider Enumeration Date:
02/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  MD21595 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)