Healthcare Provider Details

I. General information

NPI: 1346236551
Provider Name (Legal Business Name): BRYAN KEITH PERKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 02/12/2019
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 SUITE 400
INDIANAPOLIS IN
46237-8600
US

V. Phone/Fax

Practice location:
  • Phone: 317-865-3600
  • Fax: 317-885-3850
Mailing address:
  • Phone: 317-865-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01039943A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number01039943A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: