MEDICARE: BETH L BROGAN 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	207N00000X	Dermatology Physician	01059082A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000339741	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1700892809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH L BROGAN MD

Provider Business Mailing Address
First Line	:	8925 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2386
Country	:	US
Telephone Number	:	317-660-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8925 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2386
Country	:	US
Telephone Number	:	317-660-4900
Fax Number	:

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/19/2023

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Directions to “ BETH L BROGAN MD” Practice Location

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