Healthcare Provider Details

I. General information

NPI: 1407026099
Provider Name (Legal Business Name): COLLEEN CECILIA BROWN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-5425
  • Fax: 317-338-4369
Mailing address:
  • Phone: 317-338-5425
  • Fax: 317-338-4369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number01065290A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: