Individual
BRIAN J NIEDBALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4001 W GOELLER BLVD STE A, COLUMBUS, IN 47201-8309
(812) 375-3330
(812) 375-3329
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01050916A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000983450
ANTHEM PIN
IN
01
—
080170664
MEDICARE RR
—
05
—
200317250
—
IN
Enumeration date
07/24/2006
Last updated
09/09/2024
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