Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 01080124A | IN |
N | 207SG0201X | Clinical Genetics (M.D.) | 35.080322 | OH |
N | 207SG0201X | Clinical Genetics (M.D.) | 36.131389 | IL |
N | 208000000X | Pediatrician | 01080124A | IN |
NPI | 1831120229 |
---|---|
Provider Name | Bradley T Tinkle |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-2052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 26/04/2018 |