Timothy Robert Ladewig
Student in an Organized Health Care Education/Training Program in Palos Heights, IL. Individual provider (NPI-1).
NPI number1780399147
StatusActive
Last updated in NPPESJan 20, 2023
Details
- NPI
- 1780399147
- Entity type
- Individual (NPI-1)
- Name
- Timothy Robert Ladewig
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jan 20, 2023
- Certification date
- Jan 19, 2023
- Last updated
- Jan 20, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
| 2255A2300X | Specialist/Technologist, Athletic Trainer | – | – |
Practice location
50 Carriage TrlPalos Heights, IL 60463-1222
Phone 708-541-8937
Mailing address
50 Carriage TrlPalos Heights, IL 60463-1222
Phone 708-541-8937
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