Doctor Name: | DR. MATTHEW DAVID RUNNEBOHM |
NPI Number: | 1346402740 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | |
Business Practice Address: | 601 W 2nd St Bloomington, IN - 474032317 |
Business Phone Number: | 3176040059 |
Business Fax Number: | |
Mailing Address: | 2165 Harrodsburg Rd, SPRINGVILLE |
State: | IN |
Postal Code: | 474625123 |
Phone Number: | 3176040059 |
Fax Number: | |
NPI Enumeration Date: | 06/26/2008 |
NPI Last Update Date: | 09/06/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |