Healthcare Provider Details

I. General information

NPI: 1811076052
Provider Name (Legal Business Name): ROBERT F LADOVE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 01/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 TALON DR SUITE 102
O FALLON IL
62269-1848
US

IV. Provider business mailing address

916 TALON DR SUITE 102
O FALLON IL
62269-1848
US

V. Phone/Fax

Practice location:
  • Phone: 618-628-8211
  • Fax: 618-628-0883
Mailing address:
  • Phone: 618-628-8211
  • Fax: 618-628-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: