Healthcare Provider Details

I. General information

NPI: 1205913712
Provider Name (Legal Business Name): BRENT MCINTOSH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W JEFFERSON ST SUITE C
FRANKLIN IN
46131-9121
US

IV. Provider business mailing address

1300 W JEFFERSON ST SUITE C
FRANKLIN IN
46131-9121
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-8474
  • Fax: 317-736-6040
Mailing address:
  • Phone: 317-736-8474
  • Fax: 317-736-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01040646
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: