Individual
BRIAN MOLONEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1122 S IRONWOOD DR, SOUTH BEND, IN 46615-1618
(574) 472-6699
(574) 472-6698
Mailing address
PO BOX 6309, SOUTH BEND, IN 46660-6309
(574) 472-6700
(574) 472-6746
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027627
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215987
BCBS
IN
01
—
021236800
FEDERAL BLACK LUNG
IN
05
—
100222170A
—
IN
Enumeration date
05/25/2006
Last updated
02/25/2009
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