DR. LAURIE JEAN RUDNICK (NPI# 1407822612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407822612 |
| Entity Type | Individual |
| Full Name | DR. LAURIE JEAN RUDNICK |
| Other Name | LAURIE JEAN BURGOYNE |
| Credential | M.D. |
| Practice Address |
19901 E 10 Mile Rd Saint Clair Shores MI 48080-1069 |
| Practice Telephone | 5867771277 |
| Practice Fax Number | 5867770106 |
| Mailing Telephone | 5867771277 |
| Mailing Fax Number | 5867770106 |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2011-09-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 4301066008 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BCBS GROUP NUMBER | 700E031610 | 01 |
| MI | 4828442 | 05 | |
| MI | MEDICARE GROUP LEGACY # | 0P27380 | 01 |
| Street Address |
19901 E 10 MILE RD |
| City | SAINT CLAIR SHORES |
| State | MI |
| Zip Code | 48080-1069 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679881510 | St. John Hospital and Medical Center | Internal Medicine | 19901 E 10 Mile Rd, Saint Clair Shores, MI 48080-1069 | 2010-09-14 |
| 1386716520 | St. John Hospital and Medical Center | Internal Medicine | 19901 E 10 Mile Rd, Saint Clair Shores, MI 48080-1069 | 2006-11-14 |
| 1407823339 | Paul Xavier Burgoyne | Family Medicine | 19901 E 10 Mile Rd, Saint Clair Shores, MI 48080-1069 | 2006-02-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508482084 | Farrah Aleema Rajab | Family Medicine | 24911 Little Mack Avenue, Suite C, St. Clair Shores, MI 48080 | 2020-06-22 |
| 1558986141 | Julia Anastazja Krakowska | Family Medicine | 24911 Little Mack, Suite C, St. Clair Shores, MI 48080 | 2020-06-10 |
| 1972073567 | Joyce Stepnak | Social Worker | 19611 E. 8 Mile Rd, Scs, MI 48080 | 2018-11-27 |
| 1487134177 | Bonnie Girson | Social Worker | 23409 Jefferson Ave Ste 100, Saint Clair Shores, MI 48080 | 2018-08-21 |
| 1609309913 | Park Pharmacy Scs LLC | Pharmacy | 20225 E 9 Mile Rd Ste 120a, Saint Clair Shores, MI 48080 | 2017-04-05 |
| 1730564055 | Mary Rose Giroux | Psychologist | 22516 Overlake St, St. Clair Shores, MI 48080 | 2015-07-28 |
| 1962882910 | Ali Tarif Bazzy | Family Medicine | 20225 E 9 Mile Rd Ste A, Saint Clair Shores, MI 48080 | 2015-06-04 |
| 1497156228 | Kelly Zalewski | Social Worker | 24631 Jefferson Ave, Saint Clair Shores, MI 48080 | 2014-09-11 |
| 1669871364 | Mallory Margret Gordon | Psychologist | 19900 E. 10 Mile Rd., Ste. 102, Saint Clair Shores, MI 48080 | 2014-08-19 |
| 1932549375 | Alexander Peter Bill | Otolaryngology | 22631 Greater Mack Ave Ste 200, Saint Clair Shores, MI 48080 | 2013-06-30 |
| Find all providers in zip 48080 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750818118 | Dayna E Snyder | Family Medicine | 20225 E 9 Mile Rd Ste 100a, Saint Clair Shores, MI 48080-1700 | 2017-05-16 |
| 1962882910 | Ali Tarif Bazzy | Family Medicine | 20225 E 9 Mile Rd Ste A, Saint Clair Shores, MI 48080 | 2015-06-04 |
| 1407161086 | Audrey M Sim Pllc | Family Medicine | 25915 Harper Ave Ste B, Saint Clair Shores, MI 48081-3770 | 2010-08-08 |
| 1083875702 | Mark B Alrais | Family Medicine | 21600 Harper Ave Ste 100, Saint Clair Shores, MI 48080-2242 | 2008-06-25 |
| 1245327691 | Naira S. Henein | Family Medicine | 21510 Harper Ave, Saint Clair Shores, MI 48080-2211 | 2006-10-06 |
| 1154437416 | Carolyn Emily Nine | Family Medicine | 22646 E 9 Mile Rd Ste A, Saint Clair Shores, MI 48080-1951 | 2006-08-21 |
| 1124049705 | Carey Marie Vigor | Family Medicine | 24001 Greater Mack Ave Ste A, Saint Clair Shores, MI 48080-1471 | 2006-07-21 |
| 1376503151 | Rachel Eileen O'byrne | Family Medicine | 21099 Masonic Blvd, Saint Clair Shores, MI 48082-1045 | 2006-03-24 |
| 1275525966 | Sigmund O Mcintyre | Family Medicine | 24911 Little Mack Ave Ste C, Saint Clair Shores, MI 48080-3200 | 2005-08-18 |
| 1275525198 | Robin C Samyn | Family Medicine | 25631 Little Mack Ave Ste 103, Saint Clair Shores, MI 48081-2100 | 2005-08-17 |
| Find all providers in SAINT CLAIR SHORES | ||||
| City | SAINT CLAIR SHORES |
| Zip Code | 48080 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.