MEDICARE: ROGER E BROCKMAN 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	2085R0202X	Diagnostic Radiology Physician	01032980	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	822400047	OTHER	IN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629098082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER E BROCKMAN MD

Provider Business Mailing Address
First Line	:	7340 SHADELAND STA STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3980
Country	:	US
Telephone Number	:	317-579-2150
Fax Number	:	317-806-8296

Provider Business Practice Location Address
First Line	:	7340 SHADELAND STA STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3980
Country	:	US
Telephone Number	:	317-806-8260
Fax Number	:	317-806-8296

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	12/11/2018

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Directions to “ ROGER E BROCKMAN MD” Practice Location

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