Healthcare Provider Details

I. General information

NPI: 1982686499
Provider Name (Legal Business Name): SALLY L. BRADLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8111 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260-2479
US

IV. Provider business mailing address

11595 N MERIDIAN ST STE 375
CARMEL IN
46032-3950
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-7300
  • Fax: 317-575-7333
Mailing address:
  • Phone: 317-575-7300
  • Fax: 317-575-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01027005A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01027005A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: