MEDICARE: DR BRYANT KING

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	207RN0300X	Nephrology Physician
2	207R00000X	Internal Medicine Physician

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
2	1720010341	OTHER	LA	NPPES

General Provider Information

NPI Number	:	1750056586
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BRYANT KING

Provider Business Mailing Address
First Line	:	3436 KENILWORTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-2703
Country	:	US
Telephone Number	:	317-757-9731
Fax Number	:	317-983-6295

Provider Business Practice Location Address
First Line	:	1634 E MINNESOTA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-2842
Country	:	US
Telephone Number	:	317-993-2473
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNERE
Name	:	BRYANT ALAN KING
Credential	:	MD
Telephone Number	:	317-757-9731

Provider Enumeration Date	:	08/13/2021
Last Update Date	:	05/21/2025

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Directions to “DR BRYANT KING ” Practice Location

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