Individual
BRIEN N GROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1907 W SYCAMORE ST, KOKOMO, IN 46901-5148
(765) 456-5433
Mailing address
8840 COMMERCE PARK PL STE E, INDIANAPOLIS, IN 46268-3129
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
02001260A
IN
207P00000X
Emergency Medicine Physician
02001260A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000728092
ANTHEM
IN
05
—
100366310
—
IN
05
—
100366310B
—
IN
05
—
200395990A
—
IN
Enumeration date
07/19/2006
Last updated
05/20/2016
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