Healthcare Provider Details

I. General information

NPI: 1841495611
Provider Name (Legal Business Name): BRIAN L BREWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 03/07/2023
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD. SUITE 635
INDIANAPOLIS IN
46202-1212
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-1400
  • Fax: 317-963-1453
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number64004
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number64004
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01073451A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: