Healthcare Provider Details

I. General information

NPI: 1033254974
Provider Name (Legal Business Name): MICHAEL DENNIS RUDNICK M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28101 E QUINCY AVE
WATKINS CO
80137-9502
US

IV. Provider business mailing address

28101 E QUINCY AVE
WATKINS CO
80137-9502
US

V. Phone/Fax

Practice location:
  • Phone: 303-214-1131
  • Fax: 303-766-2042
Mailing address:
  • Phone: 303-214-1131
  • Fax: 303-766-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number30130
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: