Provider Demographics
NPI:1205913712
Name:MCINTOSH, BRENT (MD)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:MCINTOSH
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 1:1300 W JEFFERSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-9121
Mailing Address - Country:US
Mailing Address - Phone:317-736-8474
Mailing Address - Fax:317-736-6040
Practice Address - Street 1:1300 W JEFFERSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-9121
Practice Address - Country:US
Practice Address - Phone:317-736-8474
Practice Address - Fax:317-736-6040
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040646207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100120730Medicaid
200045318Medicare PIN
IN100120730Medicaid
IN151560WWWMedicare PIN
IN151720HHMedicare PIN