Healthcare Provider Details

I. General information

NPI: 1396748851
Provider Name (Legal Business Name): KEVIN S. LADIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 N 15TH ST STE 102
PHOENIX AZ
85020-4330
US

IV. Provider business mailing address

7600 N 15TH ST STE 102
PHOENIX AZ
85020-4330
US

V. Phone/Fax

Practice location:
  • Phone: 602-246-7410
  • Fax: 602-246-7950
Mailing address:
  • Phone: 602-246-7410
  • Fax: 602-246-7950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number20895
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number20895
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: