1831124999 NPI number — BRANDON AIMAN PA

Table of content: BRANDON AIMAN PA (NPI 1831124999)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831124999 NPI number — BRANDON AIMAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AIMAN
Provider First Name:
BRANDON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831124999
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 JACKSON ST
Provider Second Line Business Mailing Address:
#110
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-643-6012
Provider Business Mailing Address Fax Number:
765-646-9054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 JACKSON ST
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-643-6012
Provider Business Practice Location Address Fax Number:
765-646-9054
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  10000592A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000360962 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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