Healthcare Provider Details

I. General information

NPI: 1144286311
Provider Name (Legal Business Name): ADAM W. BRAZUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 09/08/2023
Certification Date: 04/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13250 HAZEL DELL PKWY STE 101
CARMEL IN
46033-8527
US

IV. Provider business mailing address

13250 HAZEL DELL PKWY STE 101
CARMEL IN
46033-8527
US

V. Phone/Fax

Practice location:
  • Phone: 317-872-1121
  • Fax:
Mailing address:
  • Phone: 317-872-1121
  • Fax: 317-810-1379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number01041551
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01041551
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: