Provider Demographics
NPI:1346483534
Name:BRYANT, ERNEST KIM
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:KIM
Last Name:BRYANT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 E 38TH ST
Mailing Address - Street 2:APT 112
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2667
Mailing Address - Country:US
Mailing Address - Phone:317-473-2548
Mailing Address - Fax:
Practice Address - Street 1:37 E 38TH ST
Practice Address - Street 2:APT 112
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2667
Practice Address - Country:US
Practice Address - Phone:317-473-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN8918213476172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver