Provider Demographics
NPI:1407834617
Name:LUDIKER, STEPHEN RANDALL (ARNP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:RANDALL
Last Name:LUDIKER
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 268838
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-8838
Mailing Address - Country:US
Mailing Address - Phone:918-619-4800
Mailing Address - Fax:918-619-4801
Practice Address - Street 1:4444 E 41ST ST
Practice Address - Street 2:1ST FLOOR, STE B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-2527
Practice Address - Country:US
Practice Address - Phone:918-619-4800
Practice Address - Fax:918-619-4801
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0032528363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKS07592Medicare UPIN