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NPI Code Detail

MEDICARE: DR. CORBY ALAN BUBP PH.D.

MEDICARE: DR. CORBY ALAN BUBP PH.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
1103G00000XClinical Neuropsychologist20042024IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1134136229
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CORBY ALAN BUBP PH.D.
Provider Business Mailing Address
First Line : 10291 N MERIDIAN ST
Second Line : STE 310
City : INDIANAPOLIS
State : IN
Zip : 46290-1083
Country : US
Telephone Number : 317-581-2288
Fax Number : 317-581-2295
Provider Business Practice Location Address
First Line : 10293 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46290-1123
Country : US
Telephone Number : 317-581-2288
Fax Number : 317-581-2295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 12/09/2019

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Directions to “ DR. CORBY ALAN BUBP PH.D.” Practice Location

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