Basic Information
| Provider Information | |||||||||
| NPI: | 1346247129 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RUDWELL | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6420 DUTCHMANS PKWY | ||||||||
| Address2: | 380 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402053372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5028948441 | ||||||||
| FaxNumber: | 8122830792 | ||||||||
| Practice Location | |||||||||
| Address1: | 1405 SPRING ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471303736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122830728 | ||||||||
| FaxNumber: | 8122830792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 12/03/2009 | ||||||||
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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 | 207Y00000X | 01020508 | IN | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 15818 | KY | N | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 040012437 | 01 | IN | RAILROAD MEDICARE | OTHER | 000000045442 | 01 | KY | ANTHEM FACET NUMBER | OTHER | 100047300A | 05 | IN | MEDICAID | 64158181 | 05 | KY | MEDICAID |