Healthcare Provider Details

I. General information

NPI: 1134165541
Provider Name (Legal Business Name): BRENDA M CACUCCI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 NORTH MERIDIAN STREET SUITE 275
CARMEL IN
46032-1405
US

IV. Provider business mailing address

13430 NORTH MERIDIAN STREET SUITE 275
CARMEL IN
46032-1405
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8403
  • Fax: 317-582-8448
Mailing address:
  • Phone: 317-582-8403
  • Fax: 317-582-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01046474A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: