Healthcare Provider Details

I. General information

NPI: 1477647600
Provider Name (Legal Business Name): GREGORY J PULAWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 E 96TH ST STE 200
INDIANAPOLIS IN
46240-3702
US

IV. Provider business mailing address

9615 IRISHMANS RUN LN
ZIONSVILLE IN
46077-8375
US

V. Phone/Fax

Practice location:
  • Phone: 317-344-9490
  • Fax:
Mailing address:
  • Phone: 317-663-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01059913
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: