Provider Demographics
NPI:1215119490
Name:LUDAG LLC DBA CANCER TREATMENT GROUP
Entity type:Organization
Organization Name:LUDAG LLC DBA CANCER TREATMENT GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:WOODBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-271-2558
Mailing Address - Street 1:840 SOUTH 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1629
Mailing Address - Country:US
Mailing Address - Phone:815-432-0057
Mailing Address - Fax:
Practice Address - Street 1:840 SOUTH 4TH ST
Practice Address - Street 2:
Practice Address - City:WATSEKA
Practice Address - State:IL
Practice Address - Zip Code:60970-1629
Practice Address - Country:US
Practice Address - Phone:815-432-0057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214152Medicare PIN