Basic Information
| Provider Information | |||||||||
| NPI: | 1457587305 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LUDEMANN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | R | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1057 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802910001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034865500 | ||||||||
| FaxNumber: | 3034865502 | ||||||||
| Practice Location | |||||||||
| Address1: | 8510 BRYANT ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800313845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034305560 | ||||||||
| FaxNumber: | 3034305565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2009 | ||||||||
| LastUpdateDate: | 06/05/2009 | ||||||||
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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 | 207Q00000X | 46150 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.