Provider Demographics
NPI:1033105390
Name:HARRISON, LUDWIKA (MD)
Entity Type:Individual
Prefix:
First Name:LUDWIKA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 LENOX AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-3819
Mailing Address - Country:US
Mailing Address - Phone:305-672-6339
Mailing Address - Fax:
Practice Address - Street 1:1ST STREET TO 65TH STREET
Practice Address - Street 2:HOUSE CALL PRACTICE
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139
Practice Address - Country:US
Practice Address - Phone:305-672-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 17057208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
91459Medicare ID - Type Unspecified
D65645Medicare UPIN