MEDICARE: BRENT A RUDISEL D.O.

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	207P00000X	Emergency Medicine Physician	02002497A	IN

General Provider Information

NPI Number	:	1477652287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT A RUDISEL D.O.

Provider Business Mailing Address
First Line	:	11523 WILDLIFE CT
Second Line	:
City	:	ZIONSVILLE
State	:	IN
Zip	:	46077-2205
Country	:	US
Telephone Number	:	317-413-9112
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 E MAIN ST
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2706
Country	:	US
Telephone Number	:	317-204-6910
Fax Number	:

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	04/07/2026

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Directions to “ BRENT A RUDISEL D.O.” Practice Location

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