Provider Demographics
NPI:1518901172
Name:LUDWIG, RODNEY A (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:A
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 GOLD DR
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6413
Mailing Address - Country:US
Mailing Address - Phone:701-280-2033
Mailing Address - Fax:701-232-5578
Practice Address - Street 1:1707 GOLD DR
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6413
Practice Address - Country:US
Practice Address - Phone:701-280-2033
Practice Address - Fax:701-232-5578
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4259207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14642Medicaid
1016747OtherPREFERRED ONE
NDD26092OtherND WORKERS COMP
MN390702300Medicaid
116064OtherUCARE
04-01614OtherMEDICA
MN163D0LUOtherMN BLUE SHIELD
ND21575OtherND BLUE SHIELD
MN163D0LUOtherMN BLUE SHIELD
ND14642Medicaid
NDD26092OtherND WORKERS COMP