Individual
DR. LAURIE JEAN RUDNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
19901 E 10 MILE RD, SAINT CLAIR SHORES, MI 48080-1069
(586) 777-1277
(586) 777-0106
Mailing address
19901 E 10 MILE RD, SAINT CLAIR SHORES, MI 48080-1069
(586) 777-1277
(586) 777-0106
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301066008
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0P27380
MEDICARE GROUP LEGACY #
MI
05
—
4828442
—
MI
01
—
700E031610
BCBS GROUP NUMBER
MI
Enumeration date
02/27/2006
Last updated
09/28/2011
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