Individual
THEODORE W BROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3611 S REED RD, STE 213, KOKOMO, IN 46902-3806
(765) 865-6076
(765) 865-6077
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01048142
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000557418
ANTHEM
IN
05
—
200188340
—
IN
Enumeration date
06/09/2005
Last updated
11/27/2023
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