Individual
DR. MICHAEL PATRICK RUDOLPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Mailing address
1000 N OAK AVE, MARSHFIELD, WI 54449-5703
(715) 387-5511
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
02003014A
IN
207L00000X
Anesthesiology Physician
Primary
35353
WI
207L00000X
Anesthesiology Physician
3564
IA
207L00000X
Anesthesiology Physician
DO0000001935
TN
207LP2900X
Pain Medicine (Anesthesiology) Physician
3564
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000391600
ANTHEM PROVIDER NUMBER
IN
05
—
0120733
—
IA
05
—
0442343
—
IA
01
—
11507531
CAQH NUMBER
IN
05
—
200802530
—
IN
01
—
4571
MEDICAL LICENSE
SD
01
—
50171
WELLMARK GROUP #
IA
01
—
9265107
PHCS PID NUMBER
IN
Enumeration date
07/07/2005
Last updated
03/19/2026
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