Provider Demographics
NPI:1336131168
Name:NOLAN, BROCK P (MD)
Entity Type:Individual
Prefix:DR
First Name:BROCK
Middle Name:P
Last Name:NOLAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:610 E SOUTHPORT RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-8590
Mailing Address - Country:US
Mailing Address - Phone:317-781-4588
Mailing Address - Fax:317-782-4885
Practice Address - Street 1:610 E SOUTHPORT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-8590
Practice Address - Country:US
Practice Address - Phone:317-781-4588
Practice Address - Fax:317-782-4885
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN1057332A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry