Individual
BRENDAN LEROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
545 VITALITY DR STE 100A, FORTVILLE, IN 46040
(317) 621-9220
(317) 621-9222
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01062433
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000566825
INDIANA BCBS/ANTHEM HEALTH
—
05
—
200830820
—
IN
01
—
9814091
AETNA HEALTH PLANS
—
01
—
P01390900
MEDICARE RR PTAN
IN
Enumeration date
10/24/2006
Last updated
11/27/2023
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