Healthcare Provider Details

I. General information

NPI: 1316953243
Provider Name (Legal Business Name): THOMAS LUDEMA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24502 PACIFIC PARK DR STE 102
ALISO VIEJO CA
92656-3033
US

IV. Provider business mailing address

24502 PACIFIC PARK DR STE 102
ALISO VIEJO CA
92656-3033
US

V. Phone/Fax

Practice location:
  • Phone: 949-365-8877
  • Fax: 949-365-8878
Mailing address:
  • Phone: 949-365-8877
  • Fax: 949-365-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG53135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: