Provider Demographics
NPI:1548256910
Name:UDEHN, DAVID DUANE (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DUANE
Last Name:UDEHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-752-1177
Mailing Address - Fax:989-752-2923
Practice Address - Street 1:800 COOPER AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5394
Practice Address - Country:US
Practice Address - Phone:989-752-1177
Practice Address - Fax:989-752-2923
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2014-06-20
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IL036063883207T00000X
MI4301095933207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDD6333OtherRAILROAD MEDICARE
MI1548256910Medicaid
IL036063883Medicaid
IL08132080OtherBLUE CROSS BLUE SHIELD
ILDD6333OtherRAILROAD MEDICARE
IL036063883Medicaid
M74750245Medicare PIN