Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4301087342 | MI |
NPI | 1063425767 |
---|---|
Provider Name | Mathew W Ludgate |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-0918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2006 |
Last Update Date | 08/07/2007 |