Healthcare Provider Details

I. General information

NPI: 1932154192
Provider Name (Legal Business Name): DEREK ANTHONY LADO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4081 CASCADE RD SE STE 700
GRAND RAPIDS MI
49546-2154
US

IV. Provider business mailing address

PO BOX 3140
GRAND RAPIDS MI
49501-3140
US

V. Phone/Fax

Practice location:
  • Phone: 616-325-1224
  • Fax: 888-972-8067
Mailing address:
  • Phone: 616-459-0898
  • Fax: 616-591-0430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number5101014670
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number5101014670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: