Healthcare Provider Details

I. General information

NPI: 1578805313
Provider Name (Legal Business Name): LEONARD T BULLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 E 136TH ST STE 2000
FISHERS IN
46037-9440
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-5980
  • Fax: 317-566-2736
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01081387A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: