Provider Demographics
NPI:1164463600
Name:VALENTINI, RUDOLPH P (MD)
Entity Type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:P
Last Name:VALENTINI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST. ANTOINE - UHC 5D MAILBOX 226
Mailing Address - Street 2:UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:CHILDRENS HOSPITAL OF MICHIGAN
Practice Address - Street 2:3901 BEAUBIEN BLVD - NEPHROLOGY
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5604
Practice Address - Fax:313-966-0039
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI43010608632080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
700H262280OtherBLUE CROSS-BLUE CROSS
RV060863OtherCHAMPUS-CHAMPUS
RV060863OtherCOMMERCIAL-COMMERCIAL NUMBER
MI339919310Medicaid
G38167Medicare UPIN