Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 01035926A | IN |
NPI | 1053356444 |
---|---|
Provider Name | Elliot H Cousins |
First Address | Indianapolis, IN 46260-2190 |
Second Address | Indianapolis, IN 46260-2190 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2006 |
Last Update Date | 30/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000083136 | BCBS PIN (01) | |
100376130A | (05) | IN |
60016008 | RAILROAD MEDICARE PIN (01) | |
D94520 | (02) |