Individual
BRADLEY SCOTT DESTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 SOUTH DR, DEPT. OF ANESTHESIA, FESLER HALL, ROOM 204, INDIANAPOLIS, IN 46202-5135
(317) 274-4343
(317) 274-0256
Mailing address
7211 ENGLISH BIRCH LN, INDIANAPOLIS, IN 46268-5726
(812) 606-6655
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01069120A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000768380
ANTHEM PTAN
IN
Enumeration date
04/09/2008
Last updated
12/02/2024
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