Individual
TERESA L RUDOLPH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1504 S COMMERCIAL ST, NEENAH, WI 54956-4802
(920) 729-6088
(920) 729-6484
Mailing address
PO BOX 8003, APPLETON, WI 54912-8003
(920) 996-3200
(920) 738-5787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31387
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31670900
—
WI
Enumeration date
06/14/2006
Last updated
04/14/2011
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