Healthcare Provider Details

I. General information

NPI: 1609821255
Provider Name (Legal Business Name): MARK W. RUDEMILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 GLENWAY AVE 205
CINCINNATI OH
45211-6378
US

IV. Provider business mailing address

PO BOX 635156
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 513-481-0900
  • Fax: 513-481-0904
Mailing address:
  • Phone: 513-481-0900
  • Fax: 513-481-0904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35047292
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: