Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 036102280 | IL |
NPI | 1255373452 |
---|---|
Provider Name | Andrew Scott Rudin |
First Address | Chicago, IL 60674-0001 |
Second Address | Winfield, IL 60190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/04/2011 |