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NPI Code Detail

MEDICARE: DR. SUSAN M RUDBERG M.D.

MEDICARE: DR. SUSAN M RUDBERG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician33631MN

General Provider Information

NPI Number : 1326002346
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN M RUDBERG M.D.
Provider Business Mailing Address
First Line : 3605 MAYFAIR AVE
Second Line :
City : HIBBING
State : MN
Zip : 55746-2923
Country : US
Telephone Number : 218-262-3441
Fax Number :
Provider Business Practice Location Address
First Line : 3605 MAYFAIR AVE
Second Line :
City : HIBBING
State : MN
Zip : 55746-2923
Country : US
Telephone Number : 218-262-3441
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 09/13/2013

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