Provider Demographics
NPI:1457468316
Name:BRUNELLE, MONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:BRUNELLE
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 1:10122 E 10TH ST
Mailing Address - Street 2:SUITE # 220
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2663
Mailing Address - Country:US
Mailing Address - Phone:317-355-2184
Mailing Address - Fax:317-355-2185
Practice Address - Street 1:10122 E 10TH ST
Practice Address - Street 2:SUITE # 220
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2663
Practice Address - Country:US
Practice Address - Phone:317-355-2184
Practice Address - Fax:317-355-2185
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00283879OtherRAILROAD MEDICARE
IN0000003897OtherANTHEM
IN100058580Medicaid
IN100058580AMedicaid
IN4004135OtherAETNA US HEALTHCARE
IN112568798OtherRAILROAD MEDICARE
IN314345668OtherTRICARE
IN6313463005OtherCIGNA HEALTHCARE
IN000000343057OtherANTHEM BCBS
IN398887OtherWELLCARE
INP00277621OtherRAILROAD MEDICARE
INB28214Medicare UPIN
IN066910Medicare PIN
IN314345668OtherTRICARE