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NPI Code Detail

MEDICARE: AVIDAH H RUDBERG M.D.

MEDICARE: AVIDAH H 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
1208800000XUrology PhysicianME142399FL

Other Identifiers

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

General Provider Information

NPI Number : 1639124779
Entity Type Code : Individual
Provider Name (Legal Business Name) : AVIDAH H RUDBERG M.D.
Provider Business Mailing Address
First Line : 6321 DANIELS PKWY STE 200
Second Line :
City : FORT MYERS
State : FL
Zip : 33912-4710
Country : US
Telephone Number : 239-416-8101
Fax Number : 239-402-8601
Provider Business Practice Location Address
First Line : 9500 BONITA BEACH RD SE STE 201
Second Line :
City : BONITA SPRINGS
State : FL
Zip : 34135-4683
Country : US
Telephone Number : 239-441-2932
Fax Number : 239-441-4045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 08/01/2025

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Directions to “ AVIDAH H RUDBERG M.D.” Practice Location

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