Provider Demographics
NPI:1194809442
Name:RUDLOWSKI, PETER (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:RUDLOWSKI
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 1:444 HOBRON LANE, SUITE 315
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815
Mailing Address - Country:US
Mailing Address - Phone:808-947-2224
Mailing Address - Fax:
Practice Address - Street 1:444 HOBRON LN STE 315
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1291
Practice Address - Country:US
Practice Address - Phone:808-947-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD 11312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI50129807Medicaid
HI50129807Medicaid
HIH54382Medicare UPIN