Provider Demographics
NPI:1427027226
Name:CAHOON, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:CAHOON
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:253 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1501
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-446-7085
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037931A2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCA18510030Medicaid
IN100098870Medicaid
IN9274784OtherPHCS PID NUMBER
IN000000188763OtherANTHEM PROVIDER NUMBER
IN10824863OtherCAQH NUMBER
IN142080XXMedicare PIN
IN9274784OtherPHCS PID NUMBER
IN100098870Medicaid
IN224390KMedicare PIN
INCA18510030Medicaid
IN185510IIMedicare PIN
IN10824863OtherCAQH NUMBER
IN815460RRRMedicare PIN
IN815510DDMedicare PIN
IN815500SSMedicare UPIN