1538480736 NPI number — KIMBALL LADIEN,MD

Table of content: (NPI 1538480736)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538480736 NPI number — KIMBALL LADIEN,MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIMBALL LADIEN,MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538480736
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
938 W NELSON ST
Provider Second Line Business Mailing Address:
FIRST FLOOR
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657-6704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-883-0200
Provider Business Mailing Address Fax Number:
773-883-0090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
938 W NELSON ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60657-6704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-883-0200
Provider Business Practice Location Address Fax Number:
773-883-0090
Provider Enumeration Date:
06/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LADIEN
Authorized Official First Name:
KIMBALL
Authorized Official Middle Name:
HENRY
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
773-883-0200

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  036076843 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 036076843 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com