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General NPI Number Information
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NPI Number | 1730418344
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Entity Type | Organization
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Legal Business Name | BREMENTOWN PHYSICIANS LLC
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 03/09/2010
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Provider Practice Location Address
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Address Line | 200 SAINT CLAIR AVE
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City | SAINT MARYS
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State | OH
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Zip | 45885-2400
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Country | US
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Telephone | 419-629-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 71 RUMMEL CREEK DR
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City | NEW BREMEN
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State | OH
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Zip | 45869-9666
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Country | US
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Telephone | 419-629-2662
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JAMES D LUEDEKE
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Credential | M.D.
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Telephone | 419-629-2662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35048500L
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License Number State | OH
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