Provider Demographics
NPI:1669435244
Name:LUEDKE, DAN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:WILLIAM
Last Name:LUEDKE
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 1:500 MEDICAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-327-1202
Mailing Address - Fax:636-327-1222
Practice Address - Street 1:1475 KISKER RD
Practice Address - Street 2:SUITE 180
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304
Practice Address - Country:US
Practice Address - Phone:636-442-7300
Practice Address - Fax:636-442-7398
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8330207RH0003X
MOR8512207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
117860OtherHEALTHLINK
MO21630OtherBCBS
830001889OtherRR MEDICARE
MO202356127Medicaid
4037806OtherAETNA
3600031OtherUHC
43616OtherGHP
A10447Medicare UPIN
MO202356127Medicaid