Provider Demographics
NPI:1730379355
Name:LUDWIG, DREW (DO)
Entity type:Individual
Prefix:
First Name:DREW
Middle Name:
Last Name:LUDWIG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4801
Mailing Address - Country:US
Mailing Address - Phone:707-525-5300
Mailing Address - Fax:
Practice Address - Street 1:5145 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3661
Practice Address - Country:US
Practice Address - Phone:773-989-3833
Practice Address - Fax:773-878-3753
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036150777207R00000X, 207RC0200X
CA20A13096207RC0200X
TXP10982086S0102X
IL125049218390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DY950OtherBLUE CROSS BLUE SHIELD
IL125049218Other125049218
TX1730379355OtherBLUE CROSS BLUE SHIELD
TXP01030494OtherRR MEDICARE
TX287720101Medicaid
TX287720102Medicaid
TXTXB140341Medicare PIN
TX298595YMVQMedicare PIN