Individual
KENNETH M BRANTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1801 N SENATE BLVD, STE 230, INDIANAPOLIS, IN 46202-1252
(317) 962-5820
(317) 962-3916
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
01071672A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
6726
NV
207RP1001X
Pulmonary Disease Physician
01071672A
IN
207RP1001X
Pulmonary Disease Physician
6726
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201165820
—
IN
05
—
2019408
—
NV
Enumeration date
05/10/2006
Last updated
02/07/2020
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