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General NPI Number Information
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NPI Number | 1700803319
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Entity Type | Individual
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Provider Name | CAROLINE M RUDNICK MD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 2325 DOUGHERTY FERRY RD
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City | ST LOUIS
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State | MO
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Zip | 63122
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Country | US
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Telephone | 314-977-9600
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Fax | 314-977-9627
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Provider Business Mailing Address
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Address Line | 3691 RUTGER AVE PROVIDER ENROLLMENT
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City | ST LOUIS
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State | MO
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Zip | 63110
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Country | US
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Telephone | 314-977-4440
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 108537
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License Number State | MO
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