Provider Demographics
NPI:1760580526
Name:HASBROOK, CHARLES F (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:HASBROOK
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 1:1670 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2182
Mailing Address - Country:US
Mailing Address - Phone:317-875-5166
Mailing Address - Fax:317-876-1670
Practice Address - Street 1:1670 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2182
Practice Address - Country:US
Practice Address - Phone:317-875-5166
Practice Address - Fax:317-876-1670
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027070174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB28294Medicare UPIN
IN078330Medicare ID - Type Unspecified