Basic Information
| Provider Information | |||||||||
| NPI: | 1184771032 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUDWIG | ||||||||
| FirstName: | BRYAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 E APPLE ST | ||||||||
| Address2: | STE 5254 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372084200 | ||||||||
| FaxNumber: | 9372084205 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 E APPLE ST | ||||||||
| Address2: | STE 5254 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454092939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372084200 | ||||||||
| FaxNumber: | 9372084205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 03/12/2013 | ||||||||
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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 | 2084N0400X | 35.094832 | OH | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2085R0204X | 35.094832 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085R0204X | 37465 | IA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 71950 | 01 | IA | WELLMARK BCBS | OTHER | 3038751 | 05 | OH | MEDICAID |