Provider Demographics
NPI:1265847719
Name:NKDHC RUDNITSKY PLLC
Entity Type:Organization
Organization Name:NKDHC RUDNITSKY PLLC
Other - Org Name:NKDHC, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ADONIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCOBEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-351-3015
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-351-3015
Mailing Address - Fax:602-224-3315
Practice Address - Street 1:2545 S BRUCE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-1718
Practice Address - Country:US
Practice Address - Phone:702-732-2438
Practice Address - Fax:702-733-7876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-24
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1265831432Medicaid
NVV108723Medicare PIN