Basic Information
| Provider Information | |||||||||
| NPI: | 1912234386 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LADAN AMINI MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15450 NORTHLINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342822020 | ||||||||
| FaxNumber: | 7342822002 | ||||||||
| Practice Location | |||||||||
| Address1: | 15450 NORTHLINE RD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SOUTHGATE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481952398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342822020 | ||||||||
| FaxNumber: | 7342822002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2009 | ||||||||
| LastUpdateDate: | 11/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | AMINI | ||||||||
| AuthorizedOfficialFirstName: | LADAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7342822020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301080497 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.