Provider Demographics
NPI:1871509216
Name:RUDOLF, RAINER A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAINER
Middle Name:A
Last Name:RUDOLF
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 1:688 BROOKWOOD LN E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-1540
Mailing Address - Country:US
Mailing Address - Phone:248-765-4638
Mailing Address - Fax:248-650-2371
Practice Address - Street 1:1135 W UNIVERSITY DR
Practice Address - Street 2:STE. 250
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-1871
Practice Address - Country:US
Practice Address - Phone:248-453-0194
Practice Address - Fax:248-453-0211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301052271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2694359Medicaid
6328694081Medicare ID - Type Unspecified
MI2694359Medicaid