Provider Demographics
NPI:1508959487
Name:COUGILL, ANDREW M (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:M
Last Name:COUGILL
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 1:10421 E COUNTY ROAD 100 N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-1243
Mailing Address - Country:US
Mailing Address - Phone:317-272-7013
Mailing Address - Fax:317-272-7007
Practice Address - Street 1:10421 E COUNTY ROAD 100 N
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-1243
Practice Address - Country:US
Practice Address - Phone:317-272-7013
Practice Address - Fax:317-272-7007
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200470630Medicaid
IN151560A6Medicare PIN
IN200470630Medicaid
IN151560A6Medicare PIN
IN228250AMedicare PIN