Healthcare Provider Details

I. General information

NPI: 1912964636
Provider Name (Legal Business Name): DONALD CRAIG BRATER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST FH 302
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

PO BOX 44994
INDIANAPOLIS IN
46244-0994
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number01035077
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: