Provider Demographics
NPI:1902020415
Name:RUDONI, PAULA MODOLO (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:MODOLO
Last Name:RUDONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3495 S CENTER RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48519-1455
Mailing Address - Country:US
Mailing Address - Phone:810-424-2011
Mailing Address - Fax:810-349-4037
Practice Address - Street 1:1096 S BELSAY RD
Practice Address - Street 2:SUITE C
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1948
Practice Address - Country:US
Practice Address - Phone:810-743-3351
Practice Address - Fax:810-244-1239
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301060063207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0500272OtherBLUE CROSS BLUE SHIELD
MI0500272OtherBLUE CROSS BLUE SHIELD