Cisco, Rudolf W

Cisco, Rudolf W is an sole proprietor health care provider with primary practice located at 1224 Sherwood Park Dr Ne , Gainesville GA 30501-3445. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, which is considered as his primary health care specialty. Cisco, Rudolf W can be contacted via phone (770) 287-0606.

Contact Information

Primary practice address
1224 Sherwood Park Dr Ne Gainesville GA 30501-3445
Phone: (770) 287-0606
Fax: (770) 287-0159
Website:
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Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery 213ES0103X 000596 Georgia

Profile Details

NPI number 1043236706
LBN Legal business name Cisco, Rudolf W
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 15th, 2006
Last updated Jan 5th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1043236706 NPPES
Georgia MEDICAID 00409274A

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