Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 01071533A | IN |
N | 207RR0500X | Rheumatology | 50212-20 | WI |
NPI | 1053598896 |
---|---|
Provider Name | Dr. Tracy M. Brenner |
First Address | Indianapolis, IN 46260-5307 |
Second Address | Indianapolis, IN 46260-5307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2008 |
Last Update Date | 26/10/2020 |