Provider Demographics
NPI:1932307758
Name:LUDWIG, KANDICE K (MD)
Entity Type:Individual
Prefix:
First Name:KANDICE
Middle Name:K
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANDICE
Other - Middle Name:E
Other - Last Name:KILBRIDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130, PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0860
Mailing Address - Fax:
Practice Address - Street 1:11725 N ILLINOIS STREET
Practice Address - Street 2:SUITE 545
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3014
Practice Address - Country:US
Practice Address - Phone:317-688-3220
Practice Address - Fax:317-688-5150
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060249208600000X
IN01068492A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000675954OtherANTHEM PIN
IN200988110Medicaid
INP01113499Medicare PIN
IN000000675954OtherANTHEM PIN