MEDICARE: BENJAMIN DAVID ULRICH CAA

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	367H00000X	Anesthesiologist Assistant	75000239A	IN

General Provider Information

NPI Number	:	1811855778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN DAVID ULRICH CAA

Provider Business Mailing Address
First Line	:	250 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 N SENATE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5306
Country	:	US
Telephone Number	:	317-962-8880
Fax Number	:

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	02/02/2026

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