Provider Demographics
NPI:1316953243
Name:LUDEMA, THOMAS (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:LUDEMA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MAREBLU STE 250
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3047
Mailing Address - Country:US
Mailing Address - Phone:949-365-8877
Mailing Address - Fax:949-365-8878
Practice Address - Street 1:15 MAREBLU STE 250
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3047
Practice Address - Country:US
Practice Address - Phone:949-365-8877
Practice Address - Fax:949-365-8878
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG531352084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G531350Medicaid
CAA52452Medicare UPIN
CAWG53135CMedicare ID - Type Unspecified