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General NPI Number Information
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NPI Number | 1366425837
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Entity Type | Individual
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Provider Name | JOHN BENET SCHUCK MD
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Gender | Male
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 301 HENRY ST
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City | NORTH VERNON
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State | IN
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Zip | 47265-1063
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Country | US
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Telephone | 812-352-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 10330 N MERIDIAN ST SUITE 201
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City | INDIANAPOLIS
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State | IN
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Zip | 46290-1024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01025690A
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License Number State | IN
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