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Contact Information

RUDOLPH F EVONICH III, MD
744 S WEBSTER AVE FL 2
GREEN BAY, WI54301-3505
 Phone: 920-433-3640
 Fax: 920-433-3716
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Cardiac Electrophysiology

207RC0001X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for RUDOLPH F EVONICH III · (Male)

NPI Number 1205909967
Status Active
Credentials MD
Entity Individual
Enumeration date 11/17/2006
Last updated 04/10/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • MI License # 4301076776
  • WI License # 21241-875
  • WI License # 77869-20
  • MI Medicaid 5184312
  • WI Medicaid 34966000
  • Other P00412659 RAILROAD MEDICARE
  • MI Other 0605210971 BLUE CROSS BLUE SHIELD
Hospital affiliation(s)
  • BELLIN MEMORIAL HSPTL - (Acute Care)
    744 S WEBSTER AVE
    GREEN BAY, WI 54305
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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