Provider Demographics
NPI:1508803081
Name:ILADA, PATRICK B (MD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:B
Last Name:ILADA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3513
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:1000 PROVIDENT DR STE C
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-3255
Practice Address - Country:US
Practice Address - Phone:574-267-8728
Practice Address - Fax:574-269-3470
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-10-01
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Provider Licenses
StateLicense IDTaxonomies
IN01054010A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200326000Medicaid
IN200326000Medicaid
H40793Medicare UPIN
453220EEMedicare PIN