Provider Demographics
NPI:1144210469
Name:RULEY, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:RULEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3416 S POST RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-8316
Mailing Address - Country:US
Mailing Address - Phone:317-862-6671
Mailing Address - Fax:317-862-3632
Practice Address - Street 1:3416 S POST RD
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-8316
Practice Address - Country:US
Practice Address - Phone:317-862-6671
Practice Address - Fax:317-862-3632
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01021564A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000354566OtherANTHEM PIN
INB29378Medicare UPIN
IN725200Medicare PIN