Individual
KATELIN R LUDKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2424 S 90TH ST, WEST ALLIS, WI 53227-2455
(414) 321-2255
(414) 321-2091
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5389
TN
363A00000X
Physician Assistant
Primary
7314
WI
363AS0400X
Surgical Physician Assistant
5389
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100286538
—
WI
Enumeration date
02/23/2023
Last updated
09/13/2024
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