Provider Demographics
NPI:1750338372
Name:COUTZ, MARLA S (MD)
Entity type:Individual
Prefix:MS
First Name:MARLA
Middle Name:S
Last Name:COUTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1331 S A ST
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-1942
Mailing Address - Country:US
Mailing Address - Phone:765-552-4698
Mailing Address - Fax:765-552-4750
Practice Address - Street 1:1331 S A ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-1942
Practice Address - Country:US
Practice Address - Phone:765-552-4698
Practice Address - Fax:765-552-4750
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010298112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE10970Medicare UPIN