Healthcare Provider Details

I. General information

NPI: 1467374157
Provider Name (Legal Business Name): LDRT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 W FAIRBANKS AVE STE 200
WINTER PARK FL
32789-4678
US

IV. Provider business mailing address

1561 W FAIRBANKS AVE STE 200
WINTER PARK FL
32789-4678
US

V. Phone/Fax

Practice location:
  • Phone: 630-606-8480
  • Fax:
Mailing address:
  • Phone: 630-606-8480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: OLGA IVANOV
Title or Position: CHIEF OPERATING OFFICER
Credential: MD
Phone: 630-606-8480