MEDICARE: DR. BROCK P NOLAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	1057332A	IN

General Provider Information

NPI Number	:	1336131168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BROCK P NOLAN M.D.

Provider Business Mailing Address
First Line	:	610 E SOUTHPORT RD
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-8590
Country	:	US
Telephone Number	:	317-781-4588
Fax Number	:	317-782-4885

Provider Business Practice Location Address
First Line	:	610 E SOUTHPORT RD
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-8590
Country	:	US
Telephone Number	:	317-781-4588
Fax Number	:	317-782-4885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	10/07/2009

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