Healthcare Provider Details

I. General information

NPI: 1356347546
Provider Name (Legal Business Name): JOHN PATRICK BRADY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 VILLAGE POINT SUITE 102
CHESTERTON IN
46304-9689
US

IV. Provider business mailing address

3100 VILLAGE POINT SUITE 102
CHESTERTON IN
46304-9689
US

V. Phone/Fax

Practice location:
  • Phone: 219-395-1046
  • Fax: 219-395-1570
Mailing address:
  • Phone: 219-395-1046
  • Fax: 219-395-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01040551A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: