Individual
LEONARD BUCCELLATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
761 45TH ST, STE 108, MUNSTER, IN 46321-2893
(219) 922-5416
(219) 922-3745
Mailing address
1040 SIERRA DR STE 400, GREENWOOD, IN 46143-7241
(317) 528-4800
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
01058760
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200493840
—
IN
01
—
M471400308
MEDICARE PTAN
IN
Enumeration date
06/06/2006
Last updated
12/20/2021
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