Provider Demographics
NPI:1578783395
Name:LADNER, KEITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:M
Last Name:LADNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 E BELLEVIEW AVE STE 320C
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2607
Mailing Address - Country:US
Mailing Address - Phone:303-253-7686
Mailing Address - Fax:
Practice Address - Street 1:8200 E BELLEVIEW AVE STE 320C
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2607
Practice Address - Country:US
Practice Address - Phone:303-253-7686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR50123207YS0123X
CO501232082S0099X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002232900Medicaid
FL149KKOtherBLUE CROSS BLUE SHIELD
CO022360OtherKAISER COMMERCIAL NUMBER
CO64138224Medicaid
FLDI726ZMedicare PIN
FL002232900Medicaid