=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912082314
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEO PLOUFFE JR. MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | ELI LILLY AND COMPANY LILLY CORPORATE CENTER
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46285-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-997-5141
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 662 MAYFAIR LN
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-8650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-277-6284
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1300X
-----------------------------------------------------
Taxonomy Name | Multi-Specialty Clinic/Center
-----------------------------------------------------
License Number | 01048385A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------