Individual
KELLY D. LUDEMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5101012386
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1600668
PHP
MI
01
—
3053302594
BCBS MI INDIVIDUAL PIN
MI
05
—
4535816
—
MI
Enumeration date
06/13/2006
Last updated
06/26/2012
Update your record
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