Individual
JOHN ULLMAN DUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8177 CLEARVISTA PKWY, INDIANAPOLIS, IN 46256-1662
(317) 621-7801
(317) 621-7205
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01069607A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201067120
—
IN
01
—
P01588227
RR MEDICARE
IN
Enumeration date
04/09/2009
Last updated
07/20/2016
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