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General NPI Number Information
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NPI Number | 1982807442
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Entity Type | Organization
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Legal Business Name | GILBERT R LADD IV MD PC
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3250 W BIG BEAVER RD # 590
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City | TROY
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State | MI
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Zip | 48084-2900
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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 | 3250 W BIG BEAVER RD # 590
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City | TROY
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State | MI
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Zip | 48084-2900
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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 | MD
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Name | DR. GILBERT R LADD IV
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Credential | MD
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Telephone | 248-290-2220
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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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