Provider Demographics
NPI:1316032758
Name:LUDES, MARK F (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:F
Last Name:LUDES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 RYANS RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-1722
Mailing Address - Country:US
Mailing Address - Phone:507-372-2921
Mailing Address - Fax:507-372-5789
Practice Address - Street 1:1216 RYANS RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1722
Practice Address - Country:US
Practice Address - Phone:507-372-2921
Practice Address - Fax:507-372-5789
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40058208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1916122Medicaid
MN125698OtherUCARE
MN54A06LUOtherBCBS MPIN
MN370011044OtherRR MEDICARE
MN863717200Medicaid
MN54A06LUOtherBCBS MPIN
MN370001598Medicare ID - Type Unspecified