Provider Demographics
NPI:1992238455
Name:BUDIMAN-STEINLEY, BRANDON TYLER KRUITBOSCH (DO)
Entity type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:TYLER KRUITBOSCH
Last Name:BUDIMAN-STEINLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:BRANDON
Other - Middle Name:TYLER KRUITBOSCH
Other - Last Name:STEINLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:355 W 16TH ST STE 4300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2394
Mailing Address - Country:US
Mailing Address - Phone:317-963-2011
Mailing Address - Fax:
Practice Address - Street 1:355 W 16TH ST STE 4300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2394
Practice Address - Country:US
Practice Address - Phone:317-963-2011
Practice Address - Fax:317-963-7068
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program