Kevin M. Rudisel, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

34148 Issued in NC

Practice address

1500 Matthews Township Pkwy
Matthews, NC 28105-4656

Phone

(704) 384-5420

Fax

(704) 384-5424

NPI assigned

Mar 14, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1053389239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-5420",
            "fax_number": "704-384-5424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 MATTHEWS TOWNSHIP PKWY",
            "city": "MATTHEWS",
            "state": "NC",
            "postal_code": "281054656",
            "telephone_number": "704-384-5420",
            "fax_number": "704-384-5424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDISEL",
        "first_name": "KEVIN",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-14",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "34148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N34148",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8973841",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Madeline Michelle Rousseaux, SLP-CCC
• Joanna Grace Rowles, M.S., CCC-SLP
• Nivedita Roy, LCAS, LCMHC
• Kristine Diane Royen, DPT
• Jillian Michelle Rubio, CCC-SLP
• Emma Rueda
• Caitlin Hope Russell, LAT, ATC
• Jeanine Renee Russman, DPT
• Kasey Renee Ruthardt
• Scott Ryals, M.D.

• Internal Medicine Physician in Matthews, NC
• Providers in Matthews, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.