MEDICARE: MRS. DIANNE KAY TRUDELL MD

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	207RR0500X	Rheumatology Physician	DT048800	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P60370	OTHER	MI	BLUE CARE NETWORK
2	1102511962	OTHER	MI	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	C1542	OTHER	MI	M-CARE
5	1826025002	OTHER	MI	HEALTH PLUS
6	4092874	OTHER	MI	AETNA

General Provider Information

NPI Number	:	1538276084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNE KAY TRUDELL MD

Provider Business Mailing Address
First Line	:	G-5085 WEST BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2922
Country	:	US
Telephone Number	:	810-230-2400
Fax Number	:	810-230-1616

Provider Business Practice Location Address
First Line	:	G-5085 WEST BRISTOL RD
Second Line	:
City	:	FLINT
State	:	MI
Zip	:	48507-2922
Country	:	US
Telephone Number	:	810-230-2400
Fax Number	:	810-230-1616

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	03/18/2015

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