Provider Demographics
NPI:1346507464
Name:RUDICK, STEVEN GREGG
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GREGG
Last Name:RUDICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 GOODMAN ST.,
Mailing Address - Street 2:ML 0781
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-584-4505
Mailing Address - Fax:513-584-0468
Practice Address - Street 1:2123 AUBURN AVE STE 136
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-206-1060
Practice Address - Fax:513-206-1062
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35135877207RC0000X, 207RI0011X
OH57.021668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346687Medicaid