Provider Demographics
NPI:1316269269
Name:LUDWIG, MICHELLE SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:SUZANNE
Last Name:LUDWIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525-A HOLLY HALL
Mailing Address - Street 2:SMITH CLINIC, ATTWELL RADIATION CENTER
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054
Mailing Address - Country:US
Mailing Address - Phone:713-566-3757
Mailing Address - Fax:
Practice Address - Street 1:2525-A HOLLY HALL
Practice Address - Street 2:SMITH CLINIC, ATTWELL RADIATION CENTER
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054
Practice Address - Country:US
Practice Address - Phone:713-566-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN52072085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216831201Medicaid
TX216831201Medicaid