Healthcare Provider Details

I. General information

NPI: 1467454686
Provider Name (Legal Business Name): ERIC LADENHEIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6145 N THESTA ST
FRESNO CA
93710-5266
US

IV. Provider business mailing address

6145 N THESTA ST
FRESNO CA
93710-5266
US

V. Phone/Fax

Practice location:
  • Phone: 559-446-1065
  • Fax: 559-272-5009
Mailing address:
  • Phone: 559-446-1065
  • Fax: 559-272-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG847370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: