Provider Demographics
NPI:1598738437
Name:MULLIS, BRIAN HEATH (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HEATH
Last Name:MULLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVENUE
Practice Address - Street 2:5TH 3RD BLDG
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5116
Practice Address - Country:US
Practice Address - Phone:317-630-7889
Practice Address - Fax:317-630-6935
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 92245174400000X
IN01061878A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200823960Medicaid
FL272599100Medicaid
IN194850EEMedicare PIN
FLU5268ZMedicare PIN
FLI 36684Medicare UPIN