Provider Demographics
NPI:1952927915
Name:RUMANCIK, BRAD EVAN
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:EVAN
Last Name:RUMANCIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BARNHILL DRIVE
Mailing Address - Street 2:EMERSON HALL 139
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3082
Mailing Address - Country:US
Mailing Address - Phone:317-278-6833
Mailing Address - Fax:
Practice Address - Street 1:545 BARNHILL DRIVE
Practice Address - Street 2:EMERSON HALL 139
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3082
Practice Address - Country:US
Practice Address - Phone:317-278-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11022271A390200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program