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General NPI Number Information
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NPI Number | 1972598787
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Entity Type | Individual
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Provider Name | LUDOVICUS DEKEYSER MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1501 WABASH SUITE #400B
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City | MICHIGAN CITY
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State | IN
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Zip | 46360
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Country | US
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Telephone | 219-877-1298
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Fax | 219-877-1016
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Provider Business Mailing Address
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Address Line | PO BOX 2000
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City | DYER
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State | IN
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Zip | 46311-0900
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Country | US
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Telephone | 219-864-2107
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Fax | 219-864-2649
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 01043064A
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License Number State | IN
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