Healthcare Provider Details

I. General information

NPI: 1346507464
Provider Name (Legal Business Name): DR. STEVEN GREGG RUDICK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 AUBURN AVE STE 136
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

234 GOODMAN ST., ML 0781
CINCINNATI OH
45219
US

V. Phone/Fax

Practice location:
  • Phone: 513-206-1060
  • Fax: 513-206-1062
Mailing address:
  • Phone: 513-584-4505
  • Fax: 513-584-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35135877
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.021668
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35135877
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: