Healthcare Provider Details

I. General information

NPI: 1942542048
Provider Name (Legal Business Name): JOAQUIN LLADO-FRAZER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SCIOTO ST STE 4
URBANA OH
43078-2251
US

IV. Provider business mailing address

901 E 104TH ST # MS 400S
KANSAS CITY MO
64131-4517
US

V. Phone/Fax

Practice location:
  • Phone: 937-653-4666
  • Fax: 937-653-3469
Mailing address:
  • Phone: 816-502-8752
  • Fax: 816-932-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101257612
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2022009851
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.146859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: