Provider Demographics
NPI:1831124999
Name:AIMAN, BRANDON (PA)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:AIMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 JACKSON ST
Mailing Address - Street 2:#110
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016
Mailing Address - Country:US
Mailing Address - Phone:765-643-6012
Mailing Address - Fax:765-646-9054
Practice Address - Street 1:2101 JACKSON ST
Practice Address - Street 2:#110
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016
Practice Address - Country:US
Practice Address - Phone:765-643-6012
Practice Address - Fax:765-646-9054
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000592A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000360962OtherBLUE CROSS BLUE SHIELD
5055540EMedicare ID - Type Unspecified
000000360962OtherBLUE CROSS BLUE SHIELD