Provider Demographics
NPI:1881766475
Name:BROWN, RENITA A (MD)
Entity type:Individual
Prefix:DR
First Name:RENITA
Middle Name:A
Last Name:BROWN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RENITA
Other - Middle Name:A
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7250 CLEARVISTA DRIVE
Mailing Address - Street 2:SUITE 375
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256
Mailing Address - Country:US
Mailing Address - Phone:317-621-2102
Mailing Address - Fax:317-621-2105
Practice Address - Street 1:7250 CLEARVISTA DRIVE
Practice Address - Street 2:SUITE 375
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256
Practice Address - Country:US
Practice Address - Phone:317-621-2102
Practice Address - Fax:317-621-2105
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034545207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100132060AMedicaid
IN337950Medicare ID - Type Unspecified
IN100132060AMedicaid