Basic Information
| Provider Information | |||||||||
| NPI: | 1710949391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEDRICK | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4750 HEMPSTEAD STATION DR | ||||||||
| Address2: | |||||||||
| City: | KETTERING | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454295164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008750136 | ||||||||
| FaxNumber: | 9376193014 | ||||||||
| Practice Location | |||||||||
| Address1: | 2213 CHERRY ST | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436082603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4192513232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 06/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35068001 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000377196 | 01 | OH | BC/BS NUMBER ST.CHARLES | OTHER | 0229434 | 05 | OH | MEDICAID | 104808619 | 05 | MI | MEDICAID | P00212618 | 01 | OH | RAILROAD MEDICARE NUMBER | OTHER | 104737079 | 05 | MI | MEDICAID | 727154 | 01 | OH | BUCKEYE COMMUNITY NUMBER | OTHER | 000000360653 | 01 | OH | BC/BS IND PROVIDER NUMBER | OTHER | 104808619 | 05 | OH | MEDICAID | P00280662 | 01 | OH | RAILROAD # AT ST. CHARLES | OTHER |