Provider Demographics
NPI:1265644090
Name:RUDLOFF, MATTHEW I (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:I
Last Name:RUDLOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S GERMANTOWN RD
Mailing Address - Street 2:CAMPBELL CLINIC PC
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-759-3100
Mailing Address - Fax:901-759-3234
Practice Address - Street 1:1211 UNION AVE SUITE 500
Practice Address - Street 2:CAMPBELL CLINIC
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104
Practice Address - Country:US
Practice Address - Phone:901-759-3100
Practice Address - Fax:901-759-3234
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45003207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS100174079Medicaid
MS00731109Medicaid
AR178192001Medicaid
TNQ016976Medicaid
MS02485008Medicaid