Provider Demographics
NPI:1659648582
Name:RUALES, STEPHANIE R (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:RUALES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9821 LIMA RD STE 103
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9281
Practice Address - Country:US
Practice Address - Phone:260-234-5400
Practice Address - Fax:260-234-5395
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01073005A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine