Healthcare Provider Details

I. General information

NPI: 1396198156
Provider Name (Legal Business Name): ELENA LADICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST ROOM 2-281M
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

3501 JOHNSON ST ROOM 2-281M
HOLLYWOOD FL
33021-5421
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-2333
  • Fax:
Mailing address:
  • Phone: 954-265-2333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME129075
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: