Provider Demographics
NPI:1972650638
Name:LUEDTKE, PATRICK FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:FRANK
Last Name:LUEDTKE
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 1:151 W. 7TH AVENUE
Mailing Address - Street 2:ROOM 420
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:87401
Mailing Address - Country:US
Mailing Address - Phone:541-682-8762
Mailing Address - Fax:541-682-2455
Practice Address - Street 1:151 W. 7TH AVENUE
Practice Address - Street 2:ROOM 420
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:87401
Practice Address - Country:US
Practice Address - Phone:541-682-8762
Practice Address - Fax:541-682-2455
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4929802-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD6885Medicaid
UTH89709Medicare UPIN