Healthcare Provider Details

I. General information

NPI: 1346878667
Provider Name (Legal Business Name): ROBERT MICHAEL DORENBUSCH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NAAB RD STE 100
INDIANAPOLIS IN
46260-1985
US

IV. Provider business mailing address

11541 E WINCHESTER LN
ELLICOTT CITY MD
21042-2040
US

V. Phone/Fax

Practice location:
  • Phone: 317-207-7411
  • Fax:
Mailing address:
  • Phone: 443-996-4400
  • Fax: 317-947-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number02008139A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: