Individual
DR. MAX H RUDICEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 747-3241
(765) 281-6567
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01023414A
IN
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
01023414A
IN
207Q00000X
Family Medicine Physician
01023414A
IN
207V00000X
Obstetrics & Gynecology Physician
01023414A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082497
BLUE CROSS/BLUE SHIELD
IN
01
—
010028934
RAILROAD MEDICARE
IN
05
—
100105790
—
IN
05
—
100105790A
—
IN
Enumeration date
07/20/2005
Last updated
02/24/2014
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