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General NPI Number Information
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NPI Number | 1427554682
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Entity Type | Individual
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Provider Name | LAURA LEDVORA MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 7808 W COLLEGE DR STE 2W
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City | PALOS HEIGHTS
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State | IL
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Zip | 60463-1098
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Country | US
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Telephone | 708-361-5110
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Fax | 708-361-5305
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Provider Business Mailing Address
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Address Line | 8531 MYRTLEWOOD AVE
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City | CINCINNATI
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State | OH
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Zip | 45236-1919
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Country | US
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Telephone | 630-222-1989
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.146902
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35.146902
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 01094758A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036.172665
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License Number State | IL
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