MEDICARE: RON LUDWISZEWSKI PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	438	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760409460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RON LUDWISZEWSKI PA-C

Provider Business Mailing Address
First Line	:	1712 WELLNESS WAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106
Country	:	US
Telephone Number	:	702-380-1712
Fax Number	:	702-852-0580

Provider Business Practice Location Address
First Line	:	5380 S RAINBOW BLVD
Second Line	:	SUITE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1877
Country	:	US
Telephone Number	:	702-791-1326
Fax Number	:	702-921-6828

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	03/17/2018

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