Provider Demographics
NPI:1497825244
Name:INTEGRATED MEDICAL DIRECTION
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL DIRECTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LADNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-272-5007
Mailing Address - Street 1:1 COUNTRY RD E
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF GOLF
Mailing Address - State:FL
Mailing Address - Zip Code:33436-5611
Mailing Address - Country:US
Mailing Address - Phone:561-272-5007
Mailing Address - Fax:
Practice Address - Street 1:1 COUNTRY RD E
Practice Address - Street 2:
Practice Address - City:VILLAGE OF GOLF
Practice Address - State:FL
Practice Address - Zip Code:33436-5611
Practice Address - Country:US
Practice Address - Phone:561-272-5007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252510100Medicaid
D50483Medicare UPIN
FL252510100Medicaid
33326Medicare ID - Type Unspecified