Provider Demographics
NPI:1194248013
Name:RUDNINGEN, KYLE ERICK (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:ERICK
Last Name:RUDNINGEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIR STE 2575
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-229-4924
Mailing Address - Fax:320-229-4971
Practice Address - Street 1:1900 CENTRACARE CIR STE 2575
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4924
Practice Address - Fax:320-229-4971
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI71434-20207N00000X
WI7125-851207N00000X
MN70700207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology