Provider Demographics
NPI:1235389859
Name:INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDOI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-481-7030
Mailing Address - Street 1:4346 LOUGHBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116-2104
Mailing Address - Country:US
Mailing Address - Phone:314-481-7030
Mailing Address - Fax:314-481-7120
Practice Address - Street 1:4346 LOUGHBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116-2104
Practice Address - Country:US
Practice Address - Phone:314-481-7030
Practice Address - Fax:314-481-7120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty