Provider Demographics
NPI:1174767271
Name:LADY, PING D (MD)
Entity type:Individual
Prefix:
First Name:PING
Middle Name:D
Last Name:LADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:PING
Other - Middle Name:
Other - Last Name:DU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1501 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54915-1846
Mailing Address - Country:US
Mailing Address - Phone:920-730-4435
Mailing Address - Fax:
Practice Address - Street 1:1501 S MADISON ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1846
Practice Address - Country:US
Practice Address - Phone:920-730-4435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI62581208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery