MEDICARE: INTERNAL MEDICINE, LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1235389859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNAL MEDICINE, LLC

Provider Business Mailing Address
First Line	:	4346 LOUGHBOROUGH AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-2104
Country	:	US
Telephone Number	:	314-481-7030
Fax Number	:	314-481-7120

Provider Business Practice Location Address
First Line	:	4346 LOUGHBOROUGH AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-2104
Country	:	US
Telephone Number	:	314-481-7030
Fax Number	:	314-481-7120

Authorized Official
Title or Position	:	OWNER
Name	:	ALEXANDER RUDOI
Credential	:	MD
Telephone Number	:	314-481-7030

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	09/19/2008

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Directions to “INTERNAL MEDICINE, LLC ” Practice Location

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