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General NPI Number Information
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NPI Number | 1437198348
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Entity Type | Individual
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Provider Name | LEONARD BUCCELLATO MD
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 12/20/2021
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Provider Practice Location Address
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Address Line | 761 45TH ST STE 108
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City | MUNSTER
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State | IN
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Zip | 46321-2893
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Country | US
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Telephone | 219-922-5416
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Fax | 219-922-3745
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Provider Business Mailing Address
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Address Line | 1040 SIERRA DR STE 400
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City | GREENWOOD
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State | IN
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Zip | 46143-7241
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Country | US
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Telephone | 317-528-4800
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 01058760
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License Number State | IN
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