Provider Demographics
NPI:1730150616
Name:GILBERT R LADD IV MD PC
Entity type:Organization
Organization Name:GILBERT R LADD IV MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LADD
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:248-290-2220
Mailing Address - Street 1:3290 WEST BIG BEAVER ROAD
Mailing Address - Street 2:SUITE 509
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084
Mailing Address - Country:US
Mailing Address - Phone:248-290-2220
Mailing Address - Fax:248-290-4019
Practice Address - Street 1:3290 WEST BIG BEAVER ROAD
Practice Address - Street 2:SUITE 509
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084
Practice Address - Country:US
Practice Address - Phone:248-290-2220
Practice Address - Fax:248-290-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010731962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM93800Medicare ID - Type Unspecified
MIF60800Medicare UPIN