Individual
DR. SHENIF LADAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12380 DE PAUL DR, BRIDGETON, MO 63044-2511
(314) 447-9700
(314) 447-9812
Mailing address
1776 WOODSTEAD CT STE 208, THE WOODLANDS, TX 77380-1480
(877) 749-7428
(512) 628-3314
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2017002247
MO
208D00000X
General Practice Physician
000000064215
TN
208D00000X
General Practice Physician
036149937
IL
208D00000X
General Practice Physician
2014-01584
NC
208D00000X
General Practice Physician
83332
SC
208D00000X
General Practice Physician
MD2021-0501
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NCL490A
MEDICARE PTAN
NC
Enumeration date
10/29/2014
Last updated
11/14/2023
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