Provider Demographics
NPI:1629025176
Name:LUDWIG, PHILLIP WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:WILLIAM
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 1:1875 NW CORPORATE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431
Mailing Address - Country:US
Mailing Address - Phone:561-997-0821
Mailing Address - Fax:561-997-0849
Practice Address - Street 1:1875 NW CORPORATE BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431
Practice Address - Country:US
Practice Address - Phone:561-997-0821
Practice Address - Fax:561-997-0849
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME45298207RC0200X
FLME445298207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041538300Medicaid
FLD21834Medicare UPIN
FL61396Medicare PIN