Provider Demographics
NPI:1538480736
Name:KIMBALL LADIEN,MD
Entity Type:Organization
Organization Name:KIMBALL LADIEN,MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:LADIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-883-0200
Mailing Address - Street 1:938 W NELSON ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6704
Mailing Address - Country:US
Mailing Address - Phone:773-883-0200
Mailing Address - Fax:773-883-0090
Practice Address - Street 1:938 W NELSON ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6704
Practice Address - Country:US
Practice Address - Phone:773-883-0200
Practice Address - Fax:773-883-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360768432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076843Medicaid
ILK40282Medicare PIN
IL036076843Medicaid