Individual
MEGAN BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
123 2ND ST, COLUMBUS, IN 47201-6705
(812) 342-3339
(812) 342-3352
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000803A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000386806
BCBS
IN
01
—
066790
SIHO
IN
01
—
P00243883
RRMC
IN
Enumeration date
02/28/2006
Last updated
04/14/2023
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