Individual
MS. STACI J LADOWITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1418 CROSS ST, STE 160, SHILOH, IL 62269-2914
(618) 607-1340
(618) 433-6492
Mailing address
PO BOX 7412011, CHICAGO, IL 60674-2011
(618) 607-1340
(618) 433-6492
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
085007299
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220076974
—
MO
Enumeration date
10/08/2019
Last updated
04/21/2025
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