Provider Demographics
NPI:1407818529
Name:PULCINI, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PULCINI
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 1:3700 BELLEMEADE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0102
Mailing Address - Country:US
Mailing Address - Phone:812-477-8808
Mailing Address - Fax:812-477-9669
Practice Address - Street 1:3700 BELLEMEADE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0102
Practice Address - Country:US
Practice Address - Phone:812-477-8808
Practice Address - Fax:812-477-9669
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024761A208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D95055Medicare UPIN
IN838580AMedicare ID - Type Unspecified