Provider Demographics
NPI:1932154192
Name:LADO, DEREK ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ANTHONY
Last Name:LADO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3140
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-3140
Mailing Address - Country:US
Mailing Address - Phone:616-459-0898
Mailing Address - Fax:616-459-6963
Practice Address - Street 1:3351 EAGLE RUN DR NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-7070
Practice Address - Country:US
Practice Address - Phone:616-325-1224
Practice Address - Fax:888-972-8067
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010146702081N0008X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII08652Medicare UPIN