Provider Demographics
NPI:1053555730
Name:BLUNCK, BRANDIE MARIE (MD)
Entity type:Individual
Prefix:
First Name:BRANDIE
Middle Name:MARIE
Last Name:BLUNCK
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 1:250 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 1:4725 STATESMEN DR
Practice Address - Street 2:STE C-D
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5644
Practice Address - Country:US
Practice Address - Phone:317-614-9850
Practice Address - Fax:800-731-0751
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072012A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology