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NPI Code Detail

MEDICARE: MIKKI B COBURN MED

MEDICARE: MIKKI B COBURN MED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-20-43590IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-20-43590OTHERINBACB CERTIFICATION

General Provider Information

NPI Number : 1447861497
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKKI B COBURN MED
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 317-939-5377
Fax Number : 317-932-7880
Provider Business Practice Location Address
First Line : 160 PLAINFIELD VILLAGE DRIVE, SUITE 101
Second Line : NULL
City : PLAINFIELD
State : IN
Zip : 46168-2782
Country : US
Telephone Number : 463-888-0118
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2020
Last Update Date : 08/13/2020

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Directions to “ MIKKI B COBURN MED” Practice Location

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