Provider Demographics
NPI:1184767238
Name:LADIZINSKY, DANIEL ALAN (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALAN
Last Name:LADIZINSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:ALAN
Other - Last Name:LADIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9900 SE SUNNYSIDE RD
Mailing Address - Street 2:KAISER PERMANENTE SUNNYBROOK MEDICAL OFFICE
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9777
Mailing Address - Country:US
Mailing Address - Phone:503-571-3162
Mailing Address - Fax:503-571-3069
Practice Address - Street 1:9900 SE SUNNYSIDE RD
Practice Address - Street 2:KASIER PERMANENTE SUNNYBROOK MEDICAL OFFICE
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9777
Practice Address - Country:US
Practice Address - Phone:503-571-3162
Practice Address - Fax:503-571-3069
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD215952086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery