Individual
MR. LARRY J BUCKEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
53 SOUTH PARK BLVD, GREENWOOD, IN 46143
(317) 889-7546
(317) 889-2482
Mailing address
53 SOUTH PARK BLVD, GREENWOOD, IN 46143
(317) 889-7546
(317) 889-2482
Taxonomy
Speciality
Code
Description
License number
State
207ND0900X
Dermatopathology Physician
Primary
01022110
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000075125
ANTHEM
IN
01
—
2053534001
CIGNA
IN
01
—
4073522
AETNA
IN
Enumeration date
09/06/2006
Last updated
07/08/2007
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