MEDICARE: ANDREW M COUGILL MD

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
1	207Q00000X	Family Medicine	01057861	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00260838	MEDICARE PIN
2	151560A6	MEDICARE PIN	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508959487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW M COUGILL MD

Provider Business Mailing Address
First Line	:	1115 N. RONALD REAGAN PARKWAY
Second Line	:	SUITE 100
City	:	AVON
State	:	IN
Zip	:	46123-6913
Country	:	US
Telephone Number	:	317-272-7013
Fax Number	:	317-272-7007

Provider Business Practice Location Address
First Line	:	1115 N. RONALD REAGAN PARKWAY
Second Line	:	SUITE 100
City	:	AVON
State	:	IN
Zip	:	46123-6913
Country	:	US
Telephone Number	:	317-272-7013
Fax Number	:	317-272-7007

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/06/2014

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Directions to “ ANDREW M COUGILL MD” Practice Location

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