Individual
MR. KEITH MICHAEL LADENDORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7447 W TALCOTT AVENUE, SUITE 512, CHICAGO, IL 60631
(847) 788-1553
(773) 577-8187
Mailing address
2650 WARRENVILLE ROAD, SUITE 280, DOWNERS GROVE, IL 60515
(630) 324-7911
(630) 324-7942
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
085-002545
IL
363AS0400X
Surgical Physician Assistant
Primary
085002545
IL
Other
Enumeration date
03/21/2007
Last updated
01/23/2023
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