Provider Demographics
NPI:1750465803
Name:LUDWIG, KIRK (MD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:
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 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:COLORECTAL SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5783
Mailing Address - Fax:414-454-0152
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5783
Practice Address - Fax:414-454-0152
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30451208600000X
NC96-00989208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1750465803Medicaid
NC8953233Medicaid
WI68086 1161Medicare PIN
WI1107 73-601Medicare PIN
WI1750465803Medicaid