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General NPI Number Information
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NPI Number | 1518221084
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Entity Type | Individual
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Provider Name | CHAD RUDNICK M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2012
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 5458 TOWN CENTER RD SUITE 13
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City | BOCA RATON
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State | FL
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Zip | 33486-1089
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Country | US
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Telephone | 561-409-6213
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Fax |
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Provider Business Mailing Address
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Address Line | 5458 TOWN CENTER RD STE 25
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City | BOCA RATON
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State | FL
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Zip | 33486-1009
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Country | US
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Telephone |
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 15759
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 117599
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License Number State | FL
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