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General NPI Number Information
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NPI Number | 1538251335
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Entity Type | Organization
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Legal Business Name | GORAN T RUDIC MD SC
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 02/21/2008
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Provider Practice Location Address
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Address Line | 5663 S 27TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53221-4107
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Country | US
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Telephone | 414-281-0251
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Fax | 414-281-0271
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Provider Business Mailing Address
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Address Line | 5663 S 27TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53221-4107
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Country | US
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Telephone | 414-281-0251
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Fax | 414-281-0271
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. DELORES G MANION
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Credential |
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Telephone | 414-281-0251
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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