Provider Demographics
NPI:1427554682
Name:LEDVORA, LAURA (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:LEDVORA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8531 MYRTLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-1919
Mailing Address - Country:US
Mailing Address - Phone:630-222-1989
Mailing Address - Fax:
Practice Address - Street 1:7808 W COLLEGE DR STE 2W
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1098
Practice Address - Country:US
Practice Address - Phone:708-361-5110
Practice Address - Fax:708-361-5305
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.146902207Q00000X, 2084P0800X
IN01094758A2084P0800X
IL036.1726652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine