Provider Demographics
NPI:1861527384
Name:EASTERN INDIANA NEUROLOGY, P.C.
Entity type:Organization
Organization Name:EASTERN INDIANA NEUROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WULFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-288-6828
Mailing Address - Street 1:1508 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4949
Mailing Address - Country:US
Mailing Address - Phone:765-288-6828
Mailing Address - Fax:765-741-3979
Practice Address - Street 1:1508 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4949
Practice Address - Country:US
Practice Address - Phone:765-288-6828
Practice Address - Fax:765-741-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010415612084N0400X
IN010287242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ING25814Medicare UPIN
IN466500Medicare ID - Type UnspecifiedJOHN D. WULFF, MD
IND69465Medicare UPIN
IN465890Medicare ID - Type UnspecifiedHAL S. DICKSON, MD