Provider Demographics
NPI:1598753758
Name:LADOUCEUR, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:LADOUCEUR
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-296-9939
Practice Address - Street 1:5651 FRIST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-2054
Practice Address - Country:US
Practice Address - Phone:615-885-0200
Practice Address - Fax:615-885-0267
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000031901207X00000X
TNMD000031901207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4342767OtherBCBS
TN3842887Medicaid
TN3842881Medicare PIN
TN3842887Medicaid
TN103I205347Medicare PIN
TN3842881Medicare PIN
TN0516031006OtherCIGNA PPO
TN4342767OtherBCBS
TN2000043639Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3842887Medicaid
TN2638088OtherAETNA HMO
TNF65887Medicare UPIN
TN103I205347Medicare PIN
TN5282039OtherAETNA PPO