Healthcare Provider Details

I. General information

NPI: 1295732923
Provider Name (Legal Business Name): MICHAEL PATRICK RUDOLPH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 S STATE ST
ABERDEEN SD
57401-4527
US

IV. Provider business mailing address

PO BOX 9168
MINNEAPOLIS MN
55480-9168
US

V. Phone/Fax

Practice location:
  • Phone: 605-622-2142
  • Fax: 605-622-5127
Mailing address:
  • Phone: 866-825-8303
  • Fax: 866-582-7105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3564
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number02003014A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35353
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number3564
License Number StateIA
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO0000001935
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: