Provider Demographics
NPI:1689663510
Name:LUDWIG, ELLSWORTH EMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLSWORTH
Middle Name:EMIL
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 1:4011 ORCHARD DR
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6190
Mailing Address - Country:US
Mailing Address - Phone:989-631-1221
Mailing Address - Fax:989-631-6686
Practice Address - Street 1:4011 ORCHARD DR
Practice Address - Street 2:SUITE 2000
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6190
Practice Address - Country:US
Practice Address - Phone:989-631-1221
Practice Address - Fax:989-631-6686
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIEL040961208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1406118Medicaid
MI1406118Medicaid
0E66017001Medicare ID - Type Unspecified
B44093Medicare UPIN