Healthcare Provider Details

I. General information

NPI: 1619504123
Provider Name (Legal Business Name): MICAH JOSEPH LUDWIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR
CHAPEL HILL NC
27514-4226
US

IV. Provider business mailing address

117 TAMWORTH CRK
DURHAM NC
27707-9632
US

V. Phone/Fax

Practice location:
  • Phone: 207-380-0318
  • Fax:
Mailing address:
  • Phone: 207-380-0318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2024-00768
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: