Healthcare Provider Details

I. General information

NPI: 1700160496
Provider Name (Legal Business Name): KEITH LADNER, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 E BELLEVIEW AVE STE 320C
GREENWOOD VILLAGE CO
80111-2607
US

IV. Provider business mailing address

5436 ILLINI WAY
BOULDER CO
80303-4212
US

V. Phone/Fax

Practice location:
  • Phone: 303-253-7686
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberDR50123
License Number StateCO

VIII. Authorized Official

Name: KEITH LADNER
Title or Position: PRESIDENT
Credential:
Phone: 303-807-7325