MEDICARE: DR. MICHAEL R RULEY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01021564A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000354566	OTHER	IN	ANTHEM PIN

General Provider Information

NPI Number	:	1144210469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R RULEY M.D.

Provider Business Mailing Address
First Line	:	3416 S POST RD
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-8316
Country	:	US
Telephone Number	:	317-862-6671
Fax Number	:	317-862-3632

Provider Business Practice Location Address
First Line	:	3416 S POST RD
Second Line	:	STE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-8316
Country	:	US
Telephone Number	:	317-862-6671
Fax Number	:	317-862-3632

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	09/12/2007

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