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NPI Code Detail

MEDICARE: ETHAN WARNER PULLIAM

MEDICARE: ETHAN WARNER PULLIAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207L00000XAnesthesiology Physician11024925AIN

General Provider Information

NPI Number : 1134935711
Entity Type Code : Individual
Provider Name (Legal Business Name) : ETHAN WARNER PULLIAM
Provider Business Mailing Address
First Line : 340 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-3082
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2001 W 86TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1902
Country : US
Telephone Number : 317-800-4940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2024
Last Update Date : 06/06/2026

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Directions to “ ETHAN WARNER PULLIAM ” Practice Location

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