Healthcare Provider Details

I. General information

NPI: 1285692194
Provider Name (Legal Business Name): SEAN FLYNN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 S LANDMARK AVE
BLOOMINGTON IN
47403-5003
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-8242
  • Fax: 812-333-7684
Mailing address:
  • Phone: 317-963-4171
  • Fax: 812-333-7684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01053213A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: