1245330208 NPI number — MICHAEL A LUDWIG MD

Table of content: MICHAEL A LUDWIG MD (NPI 1245330208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245330208 NPI number — MICHAEL A LUDWIG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUDWIG
Provider First Name:
MICHAEL
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245330208
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/31/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1839 N GOVERNMENT WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COEUR D ALENE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83814-3454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-765-0156
Provider Business Mailing Address Fax Number:
208-292-3177

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1839 N GOVERNMENT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COEUR D ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814-3454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-765-0156
Provider Business Practice Location Address Fax Number:
208-292-3177
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  M-9338 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8948153 . This is a "CRIME VICTIMS COMP FUND" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00242347 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0216896 . This is a "WASHINGTON L & I" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 75366 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010151353 . This is a "REGENCE BLUESHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 806887300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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