Healthcare Provider Details

I. General information

NPI: 1437255239
Provider Name (Legal Business Name): BRIAN HOUSTON BLACK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 INDIANAPOLIS RD STE 110
GREENCASTLE IN
46135-2407
US

IV. Provider business mailing address

1100 SOUTHFIELD DR STE 1370
PLAINFIELD IN
46168-4300
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-8453
  • Fax: 765-653-8493
Mailing address:
  • Phone: 317-837-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02002904A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02002904A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: