Healthcare Provider Details

I. General information

NPI: 1467506261
Provider Name (Legal Business Name): ROBERT G LUDWIG II CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HEALTH CENTER DRIVE SURGERY/ANESTHESIA DEPARTMENT
MATTOON IL
61938-0372
US

IV. Provider business mailing address

1000 HEALTH CENTER DRIVE SURGERY/ANESTHESIA DEPARTMENT
MATTOON IL
61938-0372
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-2440
  • Fax: 217-258-2186
Mailing address:
  • Phone: 217-258-2440
  • Fax: 217-258-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209.006428
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: