Provider Demographics
NPI:1174539084
Name:RUDNICK, LAWRENCE A (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:A
Last Name:RUDNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2162 MINT LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8014
Mailing Address - Country:US
Mailing Address - Phone:847-724-7960
Mailing Address - Fax:
Practice Address - Street 1:1044 N MOZART ST STE 405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2790
Practice Address - Country:US
Practice Address - Phone:773-292-8388
Practice Address - Fax:773-278-1242
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081384207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04927890OtherBLUE CROSS/SHIELD
ILP00356886OtherRAIL ROAD MEDICARE
ILP00356886OtherRAIL ROAD MEDICARE
IL04927890OtherBLUE CROSS/SHIELD