Provider Demographics
NPI:1144455288
Name:LUDLOW, CLAYTON TOWNE (DO)
Entity type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:TOWNE
Last Name:LUDLOW
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1819 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0018
Mailing Address - Country:US
Mailing Address - Phone:765-298-5141
Mailing Address - Fax:765-298-5883
Practice Address - Street 1:1515 NORTH MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3453
Practice Address - Country:US
Practice Address - Phone:765-298-5141
Practice Address - Fax:765-298-5883
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN01036865A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201053490Medicaid
M400070531Medicare PIN