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General NPI Number Information
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NPI Number | 1700865391
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Entity Type | Individual
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Provider Name | THOMAS MATTHEW BRADY D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/11/2006
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 1701 N SENATE BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-1239
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Country | US
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Telephone | 317-577-4200
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Fax | 317-577-9503
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 34-007181
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 02006984A
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License Number State | IN
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