Provider Demographics
NPI:1558326199
Name:RUDMAN, DAVID TODD (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:TODD
Last Name:RUDMAN
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 1:5101 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1614
Mailing Address - Country:US
Mailing Address - Phone:816-478-4200
Mailing Address - Fax:816-875-2598
Practice Address - Street 1:5701 W 119TH ST STE 425
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3755
Practice Address - Country:US
Practice Address - Phone:913-723-3387
Practice Address - Fax:816-875-2598
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000157555207Y00000X
KS04-28631207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205228307Medicaid
KS2087399601Medicaid
G76982Medicare UPIN