Individual
JEROME LUDWIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2512 E DUPONT RD, SUITE 100, FORT WAYNE, IN 46825-1675
(260) 436-6667
(260) 469-7437
Mailing address
4548 SOLUTIONS CTR # 774548, CHICAGO, IL 60677-4005
(260) 969-1950
(260) 918-2137
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01023713A
IN
208800000X
Urology Physician
35038124L
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087513
BLUE CROSS BLUE SHIELD
IN
05
—
0288817
—
OH
05
—
100401240
—
IN
01
—
340010558
RAILROAD MEDICARE
IN
Enumeration date
03/02/2006
Last updated
07/08/2011
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