Provider Demographics
NPI:1427249408
Name:LOREDO, CHARLES LUDEKE (DO)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LUDEKE
Last Name:LOREDO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:30 W MONROE ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-2420
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:13667 EUREKA RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1332
Practice Address - Country:US
Practice Address - Phone:734-553-0867
Practice Address - Fax:734-468-1156
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2020-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017345207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine