Healthcare Provider Details

I. General information

NPI: 1942202155
Provider Name (Legal Business Name): SUSAN J LADUZINSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 CROSS ST STE 160
SHILOH IL
62269-2914
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 618-607-1340
  • Fax: 618-433-6492
Mailing address:
  • Phone: 618-607-1340
  • Fax: 618-433-6492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036081547
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: