Provider Demographics
NPI:1255311544
Name:BREWER, AMBERLY (MD)
Entity Type:Individual
Prefix:
First Name:AMBERLY
Middle Name:
Last Name:BREWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 SIERRA DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7241
Mailing Address - Country:US
Mailing Address - Phone:317-528-4284
Mailing Address - Fax:317-865-8355
Practice Address - Street 1:1505 S COURT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4809
Practice Address - Country:US
Practice Address - Phone:219-757-6495
Practice Address - Fax:219-757-6481
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200532310Medicaid
IN000000721907OtherANTHEM TRADITIONAL
IN000000721907OtherANTHEM TRADITIONAL
IN200532310Medicaid
IN202790RRMedicare PIN