MEDICARE: BROOKLEY CARLINO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036.149277	IL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208000000X	Pediatrics Physician	01089090A	IN

General Provider Information

NPI Number	:	1073975678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKLEY CARLINO MD

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1426 BROAD RIPPLE AVE
Second Line	:	STE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2002
Country	:	US
Telephone Number	:	317-621-3680
Fax Number	:	317-621-3689

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	12/08/2022

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Directions to “ BROOKLEY CARLINO MD” Practice Location

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