Provider Demographics
NPI:1912082314
Name:PLOUFFE, LEO JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:PLOUFFE
Suffix:JR
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 1:662 MAYFAIR LN
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8650
Mailing Address - Country:US
Mailing Address - Phone:317-277-6284
Mailing Address - Fax:
Practice Address - Street 1:ELI LILLY AND COMPANY
Practice Address - Street 2:LILLY CORPORATE CENTER
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46285-0001
Practice Address - Country:US
Practice Address - Phone:317-997-5141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048385A261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D30482Medicare UPIN