Organization
CENTRAL INDIANA PROCTOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL E. BRODERICK D.O. (PRESIDENT)
(765) 342-3686
Entity
Organization
Contact information
Practice address
250 E HARRISON ST, MARTINSVILLE, IN 46151-1510
(765) 342-3686
(765) 342-4173
Mailing address
PO BOX 1716, MARTINSVILLE, IN 46151-0716
(765) 342-3686
(765) 342-4173
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
50003439A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB9700
RAILROAD MEDICARE
IN
Enumeration date
07/08/2006
Last updated
11/11/2010
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