Provider Demographics
NPI:1760473169
Name:LUDLOW, BRANDT L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDT
Middle Name:L
Last Name:LUDLOW
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 1:628 S CHRISTOPHER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4899
Mailing Address - Country:US
Mailing Address - Phone:812-323-0400
Mailing Address - Fax:
Practice Address - Street 1:628 S CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-4899
Practice Address - Country:US
Practice Address - Phone:812-323-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26302207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100345340AMedicaid
INB29075Medicare UPIN