Provider Demographics
NPI:1467506261
Name:LUDWIG, ROBERT G II (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:LUDWIG
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HEALTH CENTER DRIVE
Mailing Address - Street 2:SURGERY/ANESTHESIA DEPARTMENT
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-0372
Mailing Address - Country:US
Mailing Address - Phone:217-258-2440
Mailing Address - Fax:217-258-2186
Practice Address - Street 1:1000 HEALTH CENTER DRIVE
Practice Address - Street 2:SURGERY/ANESTHESIA DEPARTMENT
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-0372
Practice Address - Country:US
Practice Address - Phone:217-258-2440
Practice Address - Fax:217-258-2186
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.006428367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
793330Medicare ID - Type Unspecified