Individual
CHRISTOPHER BRANDENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
114 EXECUTIVE DR, SUITE E, LAFAYETTE, IN 47905-4883
(260) 407-8000
(260) 407-8004
Mailing address
114 EXECUTIVE DR, SUITE E, LAFAYETTE, IN 47905-4883
(260) 407-8000
(260) 407-8004
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01045285A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000365245
ANTHEM
IN
01
—
00000090520
ANTHEM
IN
05
—
200126420
—
IN
Enumeration date
07/17/2006
Last updated
03/15/2011
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