Individual
ANNE MARIE BIANCULLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01072341A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000820015
ANTHEM PROVIDER NUMBER
IN
05
—
201099160
—
IN
Enumeration date
05/02/2010
Last updated
10/04/2013
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