Provider Demographics
NPI:1083602254
Name:LUEDEKE, JAMES D (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:LUEDEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-9575
Practice Address - Street 1:4463 STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:MINSTER
Practice Address - State:OH
Practice Address - Zip Code:45865-8727
Practice Address - Country:US
Practice Address - Phone:419-628-3821
Practice Address - Fax:419-628-9501
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35048500L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3012064Medicaid
OH9934723OtherGROUP MEDICARE PTAN
OHH319420OtherMEDICARE PTAN
OH0105065OtherGROUP MEDICAID
OH1184652539OtherGROUP NPI
OH34-1689161OtherJTDM FAMILY PRACTICE, LLC