Healthcare Provider Details

I. General information

NPI: 1487642997
Provider Name (Legal Business Name): LEONARD A LADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 FOUNTAIN MEDICAL CT STE 200
BONITA SPRINGS FL
34135-4525
US

IV. Provider business mailing address

9410 FOUNTAIN MEDICAL CT STE 200
BONITA SPRINGS FL
34135-4525
US

V. Phone/Fax

Practice location:
  • Phone: 239-948-4325
  • Fax: 239-288-0574
Mailing address:
  • Phone: 239-405-2669
  • Fax: 239-288-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberME84351
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME84351
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME84351
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberME84351
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME84351
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: