Healthcare Provider Details

I. General information

NPI: 1962439539
Provider Name (Legal Business Name): JAMES BRIAN LADESICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HOLMES ST
KANSAS CITY MO
64108-2741
US

IV. Provider business mailing address

13103 W 54TH TER
SHAWNEE KS
66216-4716
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-0843
  • Fax: 816-404-5507
Mailing address:
  • Phone: 913-236-6852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2006006312
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2006006312
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2006006312
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number2006006312
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: