Provider Demographics
NPI:1386150043
Name:BRENGLE FAMILY MEDICINE
Entity type:Organization
Organization Name:BRENGLE FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT-SOLAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-252-1219
Mailing Address - Street 1:8803 N MERIDIAN ST STE 350
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5386
Mailing Address - Country:US
Mailing Address - Phone:317-252-1219
Mailing Address - Fax:
Practice Address - Street 1:8803 N MERIDIAN ST STE 350
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5386
Practice Address - Country:US
Practice Address - Phone:317-252-1219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043339A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty