Provider Demographics
NPI:1235115171
Name:HATFIELD, RUDOLPH CLINTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:CLINTON
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N MICHIGAN AVE RM 3041
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4316
Mailing Address - Country:US
Mailing Address - Phone:248-345-3090
Mailing Address - Fax:989-583-2843
Practice Address - Street 1:515 N MICHIGAN AVE RM 3041
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4316
Practice Address - Country:US
Practice Address - Phone:248-345-3090
Practice Address - Fax:989-583-2843
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011637103G00000X, 103TB0200X
MI63010111637103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ22039Medicare UPIN
MI0N96490Medicare ID - Type UnspecifiedPSYCHOLOGIST
MI0N96500Medicare ID - Type UnspecifiedPSYCHOLOGIST