Provider Demographics
NPI:1568471449
Name:RUNKLE, MAX A (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:A
Last Name:RUNKLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7825 MCFARLAND LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3628
Mailing Address - Country:US
Mailing Address - Phone:317-787-9471
Mailing Address - Fax:318-788-4746
Practice Address - Street 1:7825 MCFARLAND LN
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3628
Practice Address - Country:US
Practice Address - Phone:317-787-9471
Practice Address - Fax:318-788-4746
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01027156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100062620AMedicaid
IN080148391Medicare PIN
IND94570Medicare UPIN