Healthcare Provider Details

I. General information

NPI: 1851475362
Provider Name (Legal Business Name): MR. RUSTY ALLEN BROWNLEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 N MERIDIAN ST STE 364
CARMEL IN
46032-1405
US

IV. Provider business mailing address

13430 N MERIDIAN ST STE 364
CARMEL IN
46032-1405
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8403
  • Fax: 317-582-7316
Mailing address:
  • Phone: 317-582-8403
  • Fax: 317-582-7316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number87595
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: