Provider Demographics
NPI:1710927728
Name:LUDLOW, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 77000
Mailing Address - Street 2:DEPT # 771412
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48277-1412
Mailing Address - Country:US
Mailing Address - Phone:616-392-1816
Mailing Address - Fax:616-392-1292
Practice Address - Street 1:577 MICHIGAN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4911
Practice Address - Country:US
Practice Address - Phone:616-392-1816
Practice Address - Fax:616-392-1292
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN75601208800000X
MI4301072083208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1952507444OtherGROUP NPI
MIF49383Medicare UPIN
MI1952507444Medicare PIN