Healthcare Provider Details

I. General information

NPI: 1063410942
Provider Name (Legal Business Name): WILLIAM R NUNERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PENNSYLVANIA PKWY SUITE 225
INDIANAPOLIS IN
46280-2301
US

IV. Provider business mailing address

201 PENNSYLVANIA PKWY SUITE 225
INDIANAPOLIS IN
46280-2301
US

V. Phone/Fax

Practice location:
  • Phone: 317-573-1000
  • Fax: 317-573-0205
Mailing address:
  • Phone: 317-573-1000
  • Fax: 317-573-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number01026942A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: