Provider Demographics
NPI:1679565436
Name:LUDWIG, THEODORE M (DPM)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:M
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6191 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:HALES CORNERS
Mailing Address - State:WI
Mailing Address - Zip Code:53130-2524
Mailing Address - Country:US
Mailing Address - Phone:414-425-5140
Mailing Address - Fax:414-425-7960
Practice Address - Street 1:6191 S 108TH ST
Practice Address - Street 2:
Practice Address - City:HALES CORNERS
Practice Address - State:WI
Practice Address - Zip Code:53130-2524
Practice Address - Country:US
Practice Address - Phone:414-425-5140
Practice Address - Fax:414-425-7960
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI342-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43205700Medicaid
WIT62637Medicare UPIN
WI0220260003Medicare NSC