Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | 01025689A | IN |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 4301116252 | MI |
NPI | 1891768651 |
---|---|
Provider Name | Dr. Walter William Rudzinski |
First Address | Munising, MI 49862-1406 |
Second Address | Munising, MI 49862-1406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 19/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D69783 | (02) |