MEDICARE: JOHN PATRICK BRADY 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	207RN0300X	Nephrology Physician	01040551A	IN

General Provider Information

NPI Number	:	1356347546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PATRICK BRADY M.D.

Provider Business Mailing Address
First Line	:	3100 VILLAGE POINT
Second Line	:	SUITE 102
City	:	CHESTERTON
State	:	IN
Zip	:	46304-9689
Country	:	US
Telephone Number	:	219-395-1046
Fax Number	:	219-395-1570

Provider Business Practice Location Address
First Line	:	3100 VILLAGE POINT
Second Line	:	SUITE 102
City	:	CHESTERTON
State	:	IN
Zip	:	46304-9689
Country	:	US
Telephone Number	:	219-395-1046
Fax Number	:	219-395-1570

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

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/22/2010

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