Individual
MARK R BROADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 567-2180
(317) 567-2191
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01033734
IN
207L00000X
Anesthesiology Physician
Primary
01033734A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100067110
—
IN
Enumeration date
07/03/2006
Last updated
07/21/2021
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