Basic Information
| Provider Information | |||||||||
| NPI: | 1164463600 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VALENTINI | ||||||||
| FirstName: | RUDOLPH | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 ST. ANTOINE - UHC 5D MAILBOX 226 | ||||||||
| Address2: | UNIVERSITY PEDIATRICIANS | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482012153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137454405 | ||||||||
| FaxNumber: | 3139660665 | ||||||||
| Practice Location | |||||||||
| Address1: | CHILDRENS HOSPITAL OF MICHIGAN | ||||||||
| Address2: | 3901 BEAUBIEN BLVD - NEPHROLOGY | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137455604 | ||||||||
| FaxNumber: | 3139660039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 01/20/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0210X | 4301060863 | MI | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 700H262280 | 01 | BLUE CROSS-BLUE CROSS | OTHER | RV060863 | 01 | CHAMPUS-CHAMPUS | OTHER | RV060863 | 01 | COMMERCIAL-COMMERCIAL NUMBER | OTHER | 339919310 | 05 | MI | MEDICAID |