Thomas Steven Rudzinski, DDS
Individual provider Active NPI Dentist · Elk Rapids, MI
NPI 1114090578 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1114090578
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 11119 (MI)
- Practice address
- 140 River St
Elk Rapids, MI 48629 - Phone
- (231) 264-8176
- Fax
- (231) 264-8173
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160823000734 | MI | Order and Referring Only - Dentist |
7315232873 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11119 | MI | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11119 | MI | Yes |
Addresses
Primary practice location
140 River St
Elk Rapids, MI 48629
Mailing address
140 River St
PO Box 157
Elk Rapids, MI 49629
Phone (231) 264-8176
Other providers in Elk Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.