Provider Demographics
NPI:1992028039
Name:STEVENS, CAROLINE B (DO)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:B
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1210 MEDICAL ARTS BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-3442
Mailing Address - Country:US
Mailing Address - Phone:765-298-4545
Mailing Address - Fax:765-298-4945
Practice Address - Street 1:1210 MEDICAL ARTS BLVD STE 114
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3442
Practice Address - Country:US
Practice Address - Phone:765-298-4545
Practice Address - Fax:765-298-4945
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003636A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000805266OtherANTHEM BCBS
IN200975700Medicaid
IN200975700Medicaid