=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588628945
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RALPH BUSCHBACHER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2006
-----------------------------------------------------
Last Update Date | 09/26/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5891 TALL TIMBER RUN
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46033-8613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-679-7806
-----------------------------------------------------
Fax | 317-582-1669
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5891 TALL TIMBER RUN
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46033-8613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-679-7806
-----------------------------------------------------
Fax | 317-582-1669
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 01040214
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------