Provider Demographics
NPI:1154315463
Name:DULBERGER, PHILIP M (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:M
Last Name:DULBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N RITTER AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3027
Mailing Address - Country:US
Mailing Address - Phone:317-567-2179
Mailing Address - Fax:317-567-2191
Practice Address - Street 1:9899 E 126TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2821
Practice Address - Country:US
Practice Address - Phone:317-567-2179
Practice Address - Fax:317-567-2191
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042653207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN191870PMedicare ID - Type Unspecified
INF87296Medicare UPIN