Provider Demographics
NPI:1124136239
Name:LUDLOW, MICHAEL G (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8200 W CENTRAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-9503
Mailing Address - Country:US
Mailing Address - Phone:316-722-6260
Mailing Address - Fax:316-721-8307
Practice Address - Street 1:8200 W CENTRAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-9503
Practice Address - Country:US
Practice Address - Phone:316-722-6260
Practice Address - Fax:316-721-8307
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-20306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS080110394OtherTRAVLERS MEDICARE
KS4082956OtherAETNA
KS551OtherPREFERRED HEALTH SYSTEMS
KS051994OtherBLUE CROSS BLUE SHIELD
KS051994Medicare ID - Type Unspecified