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General NPI Number Information
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NPI Number | 1285800268
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Entity Type | Organization
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Legal Business Name | DIANNE KAY TRUDELL, MD
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 5085 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-2922
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Country | US
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Telephone | 810-230-2400
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Fax | 810-230-1616
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Provider Business Mailing Address
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Address Line | 5085 W BRISTOL RD
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City | FLINT
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State | MI
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Zip | 48507-2922
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Country | US
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Telephone | 810-230-2400
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Fax | 810-230-1616
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KRISTEN SOPKO
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Credential |
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Telephone | 810-230-1790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | DT048800
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License Number State | MI
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