Provider Demographics
NPI:1487642997
Name:LADO, LEONARD A (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:A
Last Name:LADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9410 FOUNTAIN MEDICAL CT
Mailing Address - Street 2:STE 200
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4525
Mailing Address - Country:US
Mailing Address - Phone:239-405-2669
Mailing Address - Fax:239-288-0574
Practice Address - Street 1:9410 FOUNTAIN MEDICAL CT STE 200
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4525
Practice Address - Country:US
Practice Address - Phone:239-948-4325
Practice Address - Fax:239-288-0574
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME843512084A0401X, 2084P0804X, 2084P0805X, 2084P2900X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263440600Medicaid
FL263440600Medicaid