Provider Demographics
NPI:1033324181
Name:COPLAN, BENJAMIN MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:COPLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH STREET
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-7561
Mailing Address - Fax:317-355-6096
Practice Address - Street 1:3000 S STATE ROAD 135
Practice Address - Street 2:STE 230
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9607
Practice Address - Country:US
Practice Address - Phone:317-535-0728
Practice Address - Fax:317-535-0735
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004184A2084P0804X
IL0361229612084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266180956OtherMEDICARE PIN
IN000000930209OtherANTHEM HOWARD
IN000000847585OtherANTHEM BCBS
IN000000826421OtherANTHEM BCBS
IN000000829666OtherANTHEM BCBS
IN265570005Medicare PIN
IN000000847585OtherANTHEM BCBS
IN000000826421OtherANTHEM BCBS
IN165490014Medicare PIN