Healthcare Provider Details

I. General information

NPI: 1316911894
Provider Name (Legal Business Name): THOMAS M BROGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 NAAB RD STE. 1C
INDIANAPOLIS IN
46260-5918
US

IV. Provider business mailing address

10601 E 106TH ST STE. 1C
FISHERS IN
46037-8270
US

V. Phone/Fax

Practice location:
  • Phone: 317-875-7221
  • Fax: 317-879-8063
Mailing address:
  • Phone: 317-849-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01022653A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: