Healthcare Provider Details

I. General information

NPI: 1518603042
Provider Name (Legal Business Name): BRIAN FENNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6002 E 38TH ST
INDIANAPOLIS IN
46226-5614
US

IV. Provider business mailing address

1130 W. MICHIGAN STREET FESLER HALL SUITE 204
INDIANAPOLIS IN
46202-5209
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-6002
  • Fax: 317-880-0417
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01099217A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: