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General NPI Number Information
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NPI Number | 1407941321
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Entity Type | Individual
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Provider Name | GILBERT RUSSELL LADD IV M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 09/26/2009
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Provider Practice Location Address
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Address Line | 3290 W BIG BEAVER RD STE 509
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City | TROY
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State | MI
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Zip | 48084-2917
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Country | US
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Telephone | 248-290-2220
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Fax | 248-290-4019
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Provider Business Mailing Address
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Address Line | 3290 W BIG BEAVER RD STE 509
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City | TROY
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State | MI
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Zip | 48084-2917
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Country | US
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Telephone | 248-290-2220
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Fax | 248-290-4019
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | GL073196
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License Number State | MI
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