Provider Demographics
NPI:1396748851
Name:LADIN, KEVIN S (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:LADIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 N 15TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4330
Mailing Address - Country:US
Mailing Address - Phone:602-246-7410
Mailing Address - Fax:602-246-7950
Practice Address - Street 1:7600 N 15TH ST STE 102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4330
Practice Address - Country:US
Practice Address - Phone:602-246-7410
Practice Address - Fax:602-246-7950
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ208952081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ118564Medicaid
AZE62555Medicare UPIN
AZ118564Medicaid