Provider Demographics
NPI:1508866971
Name:RUDICK, ALAN (DO)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:RUDICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 W EXCHANGE ST STE 380
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1796
Mailing Address - Country:US
Mailing Address - Phone:330-344-6676
Mailing Address - Fax:330-434-3611
Practice Address - Street 1:224 W EXCHANGE ST STE 380
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1796
Practice Address - Country:US
Practice Address - Phone:330-344-6676
Practice Address - Fax:330-434-3611
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34.004756207RC0200X
OH34.004756207RS0012X, 207RP1001X
OH34-00-4756208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0740916Medicaid
OH0740916Medicaid
E54281Medicare UPIN
OHRU0640607Medicare ID - Type Unspecified