Individual
BROCK D VANDERBUSH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6820 PARKDALE PL STE 212, INDIANAPOLIS, IN 46254-6600
(317) 216-2700
(317) 216-2777
Mailing address
250 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46219-4959
(317) 962-3834
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01082307A
IN
207Q00000X
Family Medicine Physician
82220
GA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
01082307A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2014
Last updated
06/20/2024
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