Provider Demographics
NPI:1023061991
Name:LADINE, NIELS W (DPM)
Entity type:Individual
Prefix:DR
First Name:NIELS
Middle Name:W
Last Name:LADINE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8651 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1578
Mailing Address - Country:US
Mailing Address - Phone:317-931-0664
Mailing Address - Fax:317-931-0797
Practice Address - Street 1:3221 S MEMORIAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1123
Practice Address - Country:US
Practice Address - Phone:765-529-5300
Practice Address - Fax:765-593-0743
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000966A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200441030Medicaid
INP00477105Medicare PIN
IN200441030Medicaid
IN6151770001Medicare NSC
IN192530MMedicare PIN
IN4685310001Medicare NSC
INP00088471Medicare PIN
IN255740AMedicare PIN