Healthcare Provider Details

I. General information

NPI: 1881668291
Provider Name (Legal Business Name): MARK FRANCIS RUDINSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 E MCDOWELL RD
PHOENIX AZ
85006-2612
US

IV. Provider business mailing address

4542 E MESCAL ST
PHOENIX AZ
85028-3058
US

V. Phone/Fax

Practice location:
  • Phone: 602-239-4390
  • Fax:
Mailing address:
  • Phone: 602-996-8766
  • Fax: 602-482-3744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number11283
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: