Individual
DR. LADISLAV FEDORKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1350 W BAGLEY RD, BEREA, OH 44017-2912
(440) 816-5188
Mailing address
PO BOX 638269, CINCINNATI, OH 45263-8269
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-071881
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000142087
ANTHEM
OH
01
—
0104797
UNITED HEALTHCARE
OH
05
—
2076033
—
OH
01
—
341908694027
CARESOURCE
OH
01
—
5049663
AETNA
OH
01
—
83648
QUALCHOICE
OH
01
—
F71881
SUMMACARE
OH
Enumeration date
03/31/2006
Last updated
07/21/2015
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