Provider Demographics
NPI:1740320977
Name:COONS, PHILIP MEREDITH (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MEREDITH
Last Name:COONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5309 GLEN STEWART WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-9776
Mailing Address - Country:US
Mailing Address - Phone:317-291-1336
Mailing Address - Fax:
Practice Address - Street 1:10585 N MERIDIAN ST
Practice Address - Street 2:SUITE 340
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1069
Practice Address - Country:US
Practice Address - Phone:317-293-5507
Practice Address - Fax:317-293-5507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023848A2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
INB28325Medicare UPIN
IN116660FMedicare ID - Type Unspecified