Provider Demographics
NPI:1770560047
Name:RUMPLE, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:RUMPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1331 MINNICH RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-2051
Practice Address - Country:US
Practice Address - Phone:260-425-5000
Practice Address - Fax:260-425-5048
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047180A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000111938OtherANTHEM
IN080134179OtherRAILROAD MEDICARE
IN200224150Medicaid
7915079OtherAETNA
00001928880 02OtherUNITED HEALTHCARE
IN10191OtherPHYSICIANS HEALTH PLAN
IN080134179OtherRAILROAD MEDICARE
G88924Medicare UPIN
00001928880 02OtherUNITED HEALTHCARE
IN070910IMedicare PIN