Healthcare Provider Details

I. General information

NPI: 1093966269
Provider Name (Legal Business Name): BRENT A SUOZZI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 05/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 400
INDIANAPOLIS IN
46237-8633
US

IV. Provider business mailing address

8051 S EMERSON AVE STE 400
INDIANAPOLIS IN
46237-8633
US

V. Phone/Fax

Practice location:
  • Phone: 317-790-3355
  • Fax: 317-790-3002
Mailing address:
  • Phone: 317-790-3355
  • Fax: 317-790-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01072583A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number01072583A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: