Provider Demographics
NPI:1689735102
Name:RUDNICK, STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:RUDNICK
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 1:21301 STATE ROUTE 410 E # 157
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8468
Mailing Address - Country:US
Mailing Address - Phone:532-737-5764
Mailing Address - Fax:253-220-2127
Practice Address - Street 1:6300 SAND POINT WAY NE
Practice Address - Street 2:#210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-7972
Practice Address - Country:US
Practice Address - Phone:253-693-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH20113Medicare UPIN