MEDICARE: DR. DAVID JOHN DEBROTA M.D.

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	207R00000X	Internal Medicine Physician	01033476A	IN

General Provider Information

NPI Number	:	1558451740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JOHN DEBROTA M.D.

Provider Business Mailing Address
First Line	:	LILLY CORPORATE CTR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46285-8363
Country	:	US
Telephone Number	:	317-457-9960
Fax Number	:	317-433-2815

Provider Business Practice Location Address
First Line	:	LILLY CORPORATE CTR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46285-0001
Country	:	US
Telephone Number	:	317-276-3239
Fax Number	:	317-433-2815

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	01/12/2016

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