Provider Demographics
NPI:1417925991
Name:SCHILLI, RUDOLPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:
Last Name:SCHILLI
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 1:600 SOMERSET AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINDBER
Mailing Address - State:PA
Mailing Address - Zip Code:15963-1331
Mailing Address - Country:US
Mailing Address - Phone:814-535-2511
Mailing Address - Fax:814-535-8473
Practice Address - Street 1:600 SOMERSET AVENUE
Practice Address - Street 2:
Practice Address - City:WINDBER
Practice Address - State:PA
Practice Address - Zip Code:15963-1331
Practice Address - Country:US
Practice Address - Phone:814-535-2511
Practice Address - Fax:814-535-8473
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022109E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0643815Medicaid
PA251323499OtherCHAMPUS
PA65408OtherMEDPLUS
PA089582OtherBLUE SHIELD
PA1503542OtherGATEWAY
PA089582E8POtherMEDICARE
PA143582501OtherUPMC
PA0649600OtherUNITED MINE WORKERS
PA251323499OtherCHAMPUS