Healthcare Provider Details

I. General information

NPI: 1053353094
Provider Name (Legal Business Name): DAVID J RHUDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 SAINT PAUL AVE O5
MINNEAPOLIS MN
55416-4344
US

IV. Provider business mailing address

3505 SAINT PAUL AVE
MINNEAPOLIS MN
55416-4344
US

V. Phone/Fax

Practice location:
  • Phone: 612-920-0172
  • Fax:
Mailing address:
  • Phone: 612-920-0172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number30513
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: