Individual
DR. RUDOLPH FRANCIS EVONICH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
744 S WEBSTER AVE FL 2, GREEN BAY, WI 54301-3505
(920) 433-3640
(920) 433-3716
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
21241-875
WI
207RC0001X
Clinical Cardiac Electrophysiology Physician
4301076776
MI
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
77869-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0605210971
BLUE CROSS BLUE SHIELD
MI
05
—
34966000
—
WI
05
—
5184312
—
MI
01
—
P00412659
RAILROAD MEDICARE
—
Enumeration date
11/17/2006
Last updated
04/10/2023
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