| Dr Bryant King | |
|
8315 E 56th St Ste 120 Indianapolis IN 46216-1078 | |
| (317) 757-9731 | |
| (317) 983-6295 |
| Full Name | Dr Bryant King |
|---|---|
| Speciality | Internal Medicine |
| Location | 8315 E 56th St Ste 120, Indianapolis, Indiana |
| Authorized Official Name and Position | Bryant King (CEO/OWNER/PROVIDER) |
| Authorized Official Contact | 3177579731 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Bryant King 3436 Kenilworth Dr Indianapolis IN 46228-2703 Ph: (317) 757-9731 | Dr Bryant King 8315 E 56th St Ste 120 Indianapolis IN 46216-1078 Ph: (317) 757-9731 |
| NPI Number | 1750056586 |
|---|---|
| Provider Enumeration Date | 08/13/2021 |
| Last Update Date | 08/13/2021 |
| Medicare PECOS PAC ID | 2668879172 |
|---|---|
| Medicare Enrollment ID | O20210927001894 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750056586 | NPI | - | NPPES |
| 200545640 | Medicaid | IN | |
| 1720010341 | Other | LA | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RN0300X | Internal Medicine - Nephrology | (* (Not Available)) | Secondary |
| Provider Name | Bryant A King |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1720010341 PECOS PAC ID: 4688663073 Enrollment ID: I20060109000649 |
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