Provider Demographics
NPI:1932141868
Name:RUDIKOFF, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:RUDIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:515 FAIRMOUNT AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8518
Mailing Address - Country:US
Mailing Address - Phone:443-471-0480
Mailing Address - Fax:410-584-1885
Practice Address - Street 1:1838 GREENE TREE RD STE 120
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-7108
Practice Address - Country:US
Practice Address - Phone:443-471-0480
Practice Address - Fax:410-584-1885
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2019-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD18095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD35880170Medicaid
MDB69717Medicare UPIN
MD35880170Medicaid