Individual
DR. MATTHEW DAVID RUNNEBOHM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(317) 604-0059
Mailing address
2165 HARRODSBURG RD, SPRINGVILLE, IN 47462-5123
(317) 604-0059
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01069053A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201036680
—
IN
Enumeration date
06/26/2008
Last updated
02/03/2021
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