Healthcare Provider Details

I. General information

NPI: 1508849928
Provider Name (Legal Business Name): JOSEPH M LUDWICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 KIRMAN AVE STE 401
RENO NV
89502-1360
US

IV. Provider business mailing address

3131 LA CANADA ST STE 230
LAS VEGAS NV
89169-2551
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-6644
  • Fax: 775-322-4748
Mailing address:
  • Phone: 702-732-1290
  • Fax: 702-260-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number11594
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: