Provider Demographics
NPI:1043226491
Name:RUDOLF, KRISTINE O (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:O
Last Name:RUDOLF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:688 BROOKWOOD LN E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1540
Mailing Address - Country:US
Mailing Address - Phone:248-765-4637
Mailing Address - Fax:248-650-2371
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-453-0194
Practice Address - Fax:248-453-0211
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301050542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3084686Medicaid
MI3084686Medicaid
0634224Medicare ID - Type Unspecified