Provider Demographics
NPI:1144246687
Name:RUNKLE, MARK H (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:RUNKLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 E COUNTY LINE RD
Mailing Address - Street 2:STE 6
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0989
Mailing Address - Country:US
Mailing Address - Phone:317-859-2905
Mailing Address - Fax:317-859-2909
Practice Address - Street 1:1250 E COUNTY LINE RD
Practice Address - Street 2:STE 6
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0989
Practice Address - Country:US
Practice Address - Phone:317-859-2905
Practice Address - Fax:317-859-2909
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000797213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN4743630001OtherDMERC
INDN3463OtherRAIL ROAD MEDICARE
IN200035220Medicaid
IN186990Medicare ID - Type Unspecified
IN4743630001Medicare NSC
IN4743630001OtherDMERC