Provider Demographics
NPI:1225172083
Name:FRAWLEY, BRENDAN PATRICK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:PATRICK
Last Name:FRAWLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7895 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6665
Mailing Address - Country:US
Mailing Address - Phone:219-947-1910
Mailing Address - Fax:219-942-3829
Practice Address - Street 1:7895 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-6665
Practice Address - Country:US
Practice Address - Phone:219-947-1910
Practice Address - Fax:219-942-3829
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048451208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200171280AMedicaid
IN200171280AMedicaid
ING36123Medicare UPIN