Healthcare Provider Details

I. General information

NPI: 1750056586
Provider Name (Legal Business Name): DR BRYANT KING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1634 E MINNESOTA ST
INDIANAPOLIS IN
46203-2842
US

IV. Provider business mailing address

3436 KENILWORTH DR
INDIANAPOLIS IN
46228-2703
US

V. Phone/Fax

Practice location:
  • Phone: 317-993-2473
  • Fax:
Mailing address:
  • Phone: 317-757-9731
  • Fax: 317-983-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRYANT ALAN KING
Title or Position: CEO/OWNERE
Credential: MD
Phone: 317-757-9731