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Organization
GORAN T RUDIC MD SC
Active
Organization
GORAN T RUDIC MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DELORES G MANION (BILLING MANAGER)
(414) 281-0251
Entity
Organization
Contact information
Practice address
5663 S 27TH ST, MILWAUKEE, WI 53221-4107
(414) 281-0251
(414) 281-0271
Mailing address
5663 S 27TH ST, MILWAUKEE, WI 53221-4107
(414) 281-0251
(414) 281-0271
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21281600
—
WI
01
—
DC5043
RAILROAD MEDICARE
GA
Enumeration date
09/29/2006
Last updated
02/21/2008
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