Provider Demographics
NPI:1689669251
Name:LADD, DANIEL F (PA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:F
Last Name:LADD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2386
Mailing Address - Country:US
Mailing Address - Phone:231-935-2525
Mailing Address - Fax:
Practice Address - Street 1:3537 W FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7942
Practice Address - Country:US
Practice Address - Phone:231-935-2525
Practice Address - Fax:231-935-3437
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001553363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIR67347Medicare UPIN