Individual
BRANDON MICHEAL TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-8880
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01083292A
IN
208600000X
Surgery Physician
4301109615
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301109615
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043692478
ANTHEM PTAN
IN
01
—
1102614356
ANTHEM PTAN
IN
05
—
300014111
—
IN
Enumeration date
06/22/2015
Last updated
11/25/2024
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