Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01023414A | IN |
N | 207PP0204X | Pediatric Emergency Physician | 01023414A | IN |
N | 207Q00000X | Family Doctor | 01023414A | IN |
N | 207V00000X | Obstetrician & Gynecologist | 01023414A | IN |
NPI | 1770582785 |
---|---|
Provider Name | Dr. Max H Rudicel |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Muncie, IN 47303-3428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2005 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000082497 | BLUE CROSS/BLUE SHIELD (01) | IN |
010028934 | RAILROAD MEDICARE (01) | IN |
100105790 | (05) | IN |
100105790A | (05) | IN |
B28544 | (02) | IN |
D95439 | (02) | IN |