Provider Demographics
NPI:1528112760
Name:RUDONI, MICHAEL MARK
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARK
Last Name:RUDONI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 WINTER SPRINGS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9346
Mailing Address - Country:US
Mailing Address - Phone:407-359-7246
Mailing Address - Fax:407-359-2225
Practice Address - Street 1:2200 WINTER SPRINGS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-9346
Practice Address - Country:US
Practice Address - Phone:407-359-7246
Practice Address - Fax:407-359-2225
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7195111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor