MEDICARE: BRENDON TAITT

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1598511875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDON TAITT

Provider Business Mailing Address
First Line	:	5355 ROCKY MOUNTAIN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-9050
Country	:	US
Telephone Number	:	317-246-8843
Fax Number	:

Provider Business Practice Location Address
First Line	:	5355 ROCKY MOUNTAIN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-9050
Country	:	US
Telephone Number	:	317-246-8843
Fax Number	:

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

Provider Enumeration Date	:	04/26/2024
Last Update Date	:	04/26/2024

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Directions to “ BRENDON TAITT ” Practice Location

Language	Start Address	Practice Location

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