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General NPI Number Information
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NPI Number | 1295838647
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Entity Type | Individual
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Provider Name | MARK A RUDBERG MD MPH
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 800 N WESTMORELAND RD STE 101
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City | LAKE FOREST
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State | IL
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Zip | 60045-1687
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Country | US
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Telephone | 847-234-6363
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Fax | 847-234-3233
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Provider Business Mailing Address
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Address Line | 800 N WESTMORELAND RD SUITE 101
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City | LAKE FOREST
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State | IL
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Zip | 60045-1673
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Country | US
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Telephone | 847-234-6363
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Fax | 847-234-3233
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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 | 036078815
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License Number State | IL
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