Individual
TIMOTHY J BROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
550 UNIVERSITY BLVD # UH3005, INDIANAPOLIS, IN 46202-5149
(317) 962-8851
(317) 962-5957
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01061214A
IN
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
01061214A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000668309
ANTHEM PTAN
IN
01
—
000001000789
ANTHEM PTAN
IN
01
—
1102213746
ANTHEM PTAN
IN
05
—
200534140
—
IN
Enumeration date
04/25/2006
Last updated
03/04/2025
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