Provider Demographics
NPI:1205095916
Name:RUNKE, MERIDITH ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MERIDITH
Middle Name:ANNE
Last Name:RUNKE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:ROUDEBUSH VA MEDICAL CENTER, NEUROLOGY SERVICE C-8054
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-988-2715
Mailing Address - Fax:317-988-3044
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:ROUDEBUSH VA MEDICAL CENTER, NEUROLOGY SERVICE C-8054
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-988-2715
Practice Address - Fax:317-988-3044
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2016-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01070007A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201112090Medicaid
IN201112090Medicaid
IN262210001Medicare PIN