Provider Demographics
NPI:1679506208
Name:RUDER, MICHAEL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:RUDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:650-817-8100
Mailing Address - Fax:
Practice Address - Street 1:1950 UNIVERSITY AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:E PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2250
Practice Address - Country:US
Practice Address - Phone:650-617-8100
Practice Address - Fax:650-327-2947
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52891207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA52377Medicare UPIN