Provider Demographics
NPI:1174705727
Name:ADAM W. BRAZUS MD, PC
Entity type:Organization
Organization Name:ADAM W. BRAZUS MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:BRAZUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-872-1121
Mailing Address - Street 1:8402 HARCOURT RD
Mailing Address - Street 2:#730
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2074
Mailing Address - Country:US
Mailing Address - Phone:317-872-1121
Mailing Address - Fax:317-875-9539
Practice Address - Street 1:8402 HARCOURT RD
Practice Address - Street 2:#730
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2074
Practice Address - Country:US
Practice Address - Phone:317-872-1121
Practice Address - Fax:317-875-9539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1295640001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN145390Medicare PIN
INF72287Medicare UPIN
IN1295640001Medicare NSC