Provider Demographics
NPI:1700872033
Name:ARBUCK, DMITRY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DMITRY
Middle Name:MICHAEL
Last Name:ARBUCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 PENNSYLVANIA PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-2301
Mailing Address - Country:US
Mailing Address - Phone:317-805-5500
Mailing Address - Fax:317-805-5501
Practice Address - Street 1:201 PENNSYLVANIA PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2301
Practice Address - Country:US
Practice Address - Phone:317-805-5500
Practice Address - Fax:317-805-5501
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044705174400000X
IN01044705A2084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200163070Medicaid
ININ1380005Medicare PIN
ING65830Medicare UPIN