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NPI Code Detail

MEDICARE: RONALD KEN LADOUCE NP

MEDICARE: RONALD KEN LADOUCE NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner4704256971MI

General Provider Information

NPI Number : 1154870772
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD KEN LADOUCE NP
Provider Business Mailing Address
First Line : 3304 COOLEY CT
Second Line :
City : PORTAGE
State : MI
Zip : 49024-7430
Country : US
Telephone Number : 269-349-2266
Fax Number : 269-349-0792
Provider Business Practice Location Address
First Line : 3304 COOLEY CT
Second Line :
City : PORTAGE
State : MI
Zip : 49024-7430
Country : US
Telephone Number : 269-341-6736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/23/2016
Last Update Date : 05/11/2026

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Directions to “ RONALD KEN LADOUCE NP” Practice Location

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