Individual
LEO T D'AMBROSIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8051 S EMERSON AVE STE 350, INDIANAPOLIS, IN 46237-8634
(317) 859-1020
(317) 859-4040
Mailing address
6983 HILLSDALE CT, INDIANAPOLIS, IN 46250-2054
(317) 849-8350
(317) 576-6311
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01034457A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000089473
ANTHEM BXBS
IN
05
—
100129690
—
IN
Enumeration date
06/09/2005
Last updated
03/22/2021
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