Provider Demographics
NPI:1023183209
Name:RULLO, CHRISTINE ANKARET (PAC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANKARET
Last Name:RULLO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-2129
Mailing Address - Fax:
Practice Address - Street 1:500 ARCADE AVE STE 230
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2485
Practice Address - Country:US
Practice Address - Phone:574-522-6565
Practice Address - Fax:574-522-5572
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000246A363A00000X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01293850OtherRR MEDICARE
IN000000720260OtherANTHEM PROVIDER NUMBER
IN000000851237OtherBCBS BMG CARDIOTHORACIC SURGERY ELKHART
P96574Medicare UPIN
IN000000851237OtherBCBS BMG CARDIOTHORACIC SURGERY ELKHART
IN236040037Medicare PIN