Healthcare Provider Details

I. General information

NPI: 1932165479
Provider Name (Legal Business Name): BRETT W ENGBRECHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

8402 HARCOURT RD STE 830
INDIANAPOLIS IN
46260-2096
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-8857
  • Fax: 317-338-8858
Mailing address:
  • Phone: 317-338-8857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD060010L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD060010L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: