MEDICARE: ICU NJ, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093123309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICU NJ, PC

Provider Business Mailing Address
First Line	:	PO BOX 743083
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3083
Country	:	US
Telephone Number	:	561-299-3667
Fax Number	:	561-299-3670

Provider Business Practice Location Address
First Line	:	1825 NW CORPORATE BLVD STE 105
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33431-8554
Country	:	US
Telephone Number	:	561-299-3667
Fax Number	:	561-299-3670

Authorized Official
Title or Position	:	OWNER
Name	:	PHILIP LUDWIG
Credential	:	MD
Telephone Number	:	561-299-3667

Provider Enumeration Date	:	07/30/2014
Last Update Date	:	04/05/2023

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Directions to “ICU NJ, PC ” Practice Location

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