MEDICARE: DR. LEONARD DALE GUYER M.D.

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
1	207Q00000X	Family Medicine Physician	01040481	IN

General Provider Information

NPI Number	:	1407072325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD DALE GUYER M.D.

Provider Business Mailing Address
First Line	:	10778 PINE VALLEY CT
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46037-9194
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 E 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-1806
Country	:	US
Telephone Number	:	317-580-9355
Fax Number	:	317-580-9342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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