Healthcare Provider Details

I. General information

NPI: 1457468316
Provider Name (Legal Business Name): MONICA BRUNELLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10122 E 10TH ST SUITE # 220
INDIANAPOLIS IN
46229-2663
US

IV. Provider business mailing address

10122 E 10TH ST SUITE # 220
INDIANAPOLIS IN
46229-2663
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-2184
  • Fax: 317-355-2185
Mailing address:
  • Phone: 317-355-2184
  • Fax: 317-355-2185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01024979
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: