Provider Demographics
NPI:1407941321
Name:LADD, GILBERT RUSSELL IV (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:RUSSELL
Last Name:LADD
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3290 W BIG BEAVER RD STE 509
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2917
Mailing Address - Country:US
Mailing Address - Phone:248-290-2220
Mailing Address - Fax:248-290-4019
Practice Address - Street 1:3290 W BIG BEAVER RD STE 509
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2917
Practice Address - Country:US
Practice Address - Phone:248-290-2220
Practice Address - Fax:248-290-4019
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MIGL0731962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI38-3513013OtherTAX ID#
MIF60800Medicare UPIN
MI38-3513013OtherTAX ID#