Provider Demographics
NPI:1568402444
Name:LADIA & LADIA MDS PA
Entity Type:Organization
Organization Name:LADIA & LADIA MDS PA
Other - Org Name:LILIA DIZON LADIA MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LADIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-763-6431
Mailing Address - Street 1:210 NE 19TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-1932
Mailing Address - Country:US
Mailing Address - Phone:863-763-6431
Mailing Address - Fax:863-763-2319
Practice Address - Street 1:208 & 210 NE 19TH DRIVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1932
Practice Address - Country:US
Practice Address - Phone:863-763-6431
Practice Address - Fax:863-763-2319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0022705207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D85755Medicare UPIN
FL47027XMedicare ID - Type Unspecified