Healthcare Provider Details

I. General information

NPI: 1932372711
Provider Name (Legal Business Name): LINDSAY H RUDHMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST # 400
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

1 WESTBROOK CORPORATE CTR STE 240
WESTCHESTER IL
60154-5764
US

V. Phone/Fax

Practice location:
  • Phone: 312-243-4244
  • Fax: 312-942-1517
Mailing address:
  • Phone: 708-236-2601
  • Fax: 312-942-1517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085003203
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: