Provider Demographics
NPI:1316911894
Name:BROGAN, THOMAS M (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:BROGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10601 E 106TH ST
Mailing Address - Street 2:STE. 1C
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-8270
Mailing Address - Country:US
Mailing Address - Phone:317-849-9297
Mailing Address - Fax:
Practice Address - Street 1:8424 NAAB RD
Practice Address - Street 2:STE. 1C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5918
Practice Address - Country:US
Practice Address - Phone:317-875-7221
Practice Address - Fax:317-879-8063
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01022653A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100047380Medicaid
IN145660Medicare PIN
INB28025Medicare UPIN
IN898190G4Medicare PIN