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General NPI Number Information
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NPI Number | 1053363531
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Entity Type | Individual
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Provider Name | LADONNA L IMMKEN MD
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 01/10/2012
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Provider Practice Location Address
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Address Line | 6811 AUSTIN CENTER BLVD SUITE #400
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City | AUSTIN
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State | TX
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Zip | 78731-3146
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Country | US
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Telephone | 512-628-1840
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Fax | 512-628-1840
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Provider Business Mailing Address
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Address Line | 1301 BARBARA JORDAN BLVD STE 200
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City | AUSTIN
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State | TX
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Zip | 78723-3078
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Country | US
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Telephone | 512-628-1840
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Fax | 512-628-1840
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number | G4018
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License Number State | TX
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