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General NPI Number Information
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NPI Number | 1578866083
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Entity Type | Organization
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Legal Business Name | BROOKS MED GROUP CO
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Dates
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Enumeration Date | 12/06/2010
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Last Update Date | 12/06/2010
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Provider Practice Location Address
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Address Line | 5144 E STOP 11 RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-8674
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Country | US
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Telephone | 317-487-9287
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Fax |
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Provider Business Mailing Address
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Address Line | 5144 E STOP 11 RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-8674
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Country | US
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Telephone | 317-487-9287
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL CHADWICK
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Credential |
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Telephone | 317-487-9287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 01024444A
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License Number State | IN
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