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General NPI Number Information
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NPI Number | 1013286491
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Entity Type | Individual
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Provider Name | HENRY JOSEPH RUDER M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/14/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 411 LATHROP AVE UNIT 3E
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City | RIVER FOREST
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State | IL
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Zip | 60305-1894
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Country | US
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Telephone | 708-542-9359
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Fax | 708-575-0882
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Provider Business Mailing Address
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Address Line | 411 LATHROP AVE UNIT 3E
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City | RIVER FOREST
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State | IL
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Zip | 60305-1894
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Country | US
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Telephone | 708-542-9359
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Fax | 708-575-0882
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036046038
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License Number State | IL
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