Doctor Name: | DR. RUDOLF VEDO |
NPI Number: | 1710257787 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 036.047134 |
Business Practice Address: | 5833 Nebeshone Ln Rockford, IL - 611038928 |
Business Phone Number: | 8158775297 |
Business Fax Number: | |
Mailing Address: | 5833 Nebeshone Ln, ROCKFORD |
State: | IL |
Postal Code: | 611038928 |
Phone Number: | 8158775297 |
Fax Number: | |
NPI Enumeration Date: | 01/09/2012 |
NPI Last Update Date: | 01/09/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 036.047134 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |