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NPI Code Detail

MEDICARE: DR. LADD DANIEL LAKE M.D.

MEDICARE: DR. LADD DANIEL LAKE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician22147NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1243897OTHERNEMIDLANDS CHOICE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
31603089OTHERNESHARE ADVANTAGE
4605082700OTHERNEUS DEPARTMENT OF LABOR
504192OTHERNEBC/BS OF NEBRASKA
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
720050OTHERIAWELLMARK BC/BS

General Provider Information

NPI Number : 1023076874
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LADD DANIEL LAKE M.D.
Provider Business Mailing Address
First Line : PO BOX 362
Second Line :
City : NORTH PLATTE
State : NE
Zip : 69103-0362
Country : US
Telephone Number : 866-477-7013
Fax Number : 866-902-2445
Provider Business Practice Location Address
First Line : 601 W LEOTA ST
Second Line :
City : NORTH PLATTE
State : NE
Zip : 69101-6525
Country : US
Telephone Number : 308-696-7491
Fax Number : 308-696-7432
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2006
Last Update Date : 05/31/2016

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