Basic Information
Provider Information
NPI: 1578531026
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LUDWIG
FirstName: MARK
MiddleName: A
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 838
Address2:  
City: SHAWNEE MISSION
State: KS
PostalCode: 662010838
CountryCode: US
TelephoneNumber: 9134694244
FaxNumber: 9134691939
Practice Location
Address1: 17065 S US HIGHWAY 71
Address2:  
City: BELTON
State: MO
PostalCode: 640122165
CountryCode: US
TelephoneNumber: 8163481250
FaxNumber: 8163481205
Other Information
ProviderEnumerationDate: 03/10/2006
LastUpdateDate: 09/21/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XR7735MOY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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