Provider Demographics
NPI:1346255924
Name:ERIC LADENHEIM MD INC
Entity Type:Organization
Organization Name:ERIC LADENHEIM MD INC
Other - Org Name:LADENHEIM DIALYSIS ACCESS CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:LADENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-436-8173
Mailing Address - Street 1:6145 N THESTA ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5266
Mailing Address - Country:US
Mailing Address - Phone:559-436-8173
Mailing Address - Fax:559-272-5009
Practice Address - Street 1:6145 N THESTA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5266
Practice Address - Country:US
Practice Address - Phone:559-436-8173
Practice Address - Fax:559-272-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G847370208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ25116ZMedicare PIN