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General NPI Number Information
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NPI Number | 1679519508
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Entity Type | Individual
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Provider Name | SUSAN L LUEDKE M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/20/2006
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 6435 CHIPPEWA ST
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City | SAINT LOUIS
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State | MO
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Zip | 63109-2104
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Country | US
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Telephone | 315-353-1870
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Fax | 314-353-0315
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Provider Business Mailing Address
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Address Line | 15945 CLAYTON RD SUITE 120
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City | BALLWIN
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State | MO
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Zip | 63011-2490
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Country | US
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Telephone | 636-256-5000
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Fax | 636-256-5100
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | R8493
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | R8493
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License Number State | MO
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