Provider Demographics
NPI:1942202155
Name:LADUZINSKY, SUSAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:LADUZINSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 CROSS ST
Mailing Address - Street 2:STE 160
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2914
Mailing Address - Country:US
Mailing Address - Phone:618-607-1339
Mailing Address - Fax:618-433-6492
Practice Address - Street 1:1418 CROSS ST
Practice Address - Street 2:STE 160
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-2914
Practice Address - Country:US
Practice Address - Phone:618-607-1320
Practice Address - Fax:618-433-6492
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360815472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200057312Medicaid
IL036081547Medicaid
IL036081547Medicaid