Healthcare Provider Details

I. General information

NPI: 1447694468
Provider Name (Legal Business Name): RUDO MASHINDI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2013
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E BOYD AVE STE 120
GREENFIELD IN
46140-2832
US

IV. Provider business mailing address

ONE MEMORIAL SQUARE SUITE 50
GREENFIELD IN
46140-1270
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-3441
  • Fax: 317-477-6316
Mailing address:
  • Phone: 317-468-6270
  • Fax: 317-468-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036141131
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR3267
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036141131
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01079770A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: