Individual
SCOTT BRUINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4747 N MERIDIAN ST, INDIANAPOLIS, IN 46208-3539
(317) 283-5753
Mailing address
4747 N MERIDIAN ST, INDIANAPOLIS, IN 46208-3539
(317) 283-5753
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01027233
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100059200
—
IN
01
—
225210R
MEDICARE GROUP MEMBER PIN/PTAN
IN
Enumeration date
10/24/2006
Last updated
05/07/2009
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