Healthcare Provider Details

I. General information

NPI: 1841292778
Provider Name (Legal Business Name): STEPHEN ANDREW COULSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 N MERIDIAN ST STE 302
CARMEL IN
46032-7104
US

IV. Provider business mailing address

1115 MARGATE LN
LIBERTYVILLE IL
60048-2441
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-6050
  • Fax: 317-415-6060
Mailing address:
  • Phone: 847-910-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036-098320
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-098320
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number036-098320
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036-098320
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01091281A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: