MEDICARE: MARK W. RUDEMILLER 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
1	207Q00000X	Family Medicine Physician	35047292	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609821255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK W. RUDEMILLER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 635156
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-0001
Country	:	US
Telephone Number	:	513-481-0900
Fax Number	:	513-481-0904

Provider Business Practice Location Address
First Line	:	6350 GLENWAY AVE
Second Line	:	205
City	:	CINCINNATI
State	:	OH
Zip	:	45211-6378
Country	:	US
Telephone Number	:	513-481-0900
Fax Number	:	513-481-0904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	11/15/2011

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