MEDICARE: BRUCE DUANE IPPEL MD

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	01026974	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1336160266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE DUANE IPPEL MD

Provider Business Mailing Address
First Line	:	4808 VIKING TRL
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-8810
Country	:	US
Telephone Number	:	765-836-4874
Fax Number	:	765-836-5400

Provider Business Practice Location Address
First Line	:	4808 VIKING TRL
Second Line	:
City	:	NEW CASTLE
State	:	IN
Zip	:	47362-8810
Country	:	US
Telephone Number	:	765-836-4874
Fax Number	:	765-836-5400

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	07/06/2010

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