Healthcare Provider Details

I. General information

NPI: 1952305534
Provider Name (Legal Business Name): MEREDITH W COUSIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 350
INDIANAPOLIS IN
46237-8634
US

IV. Provider business mailing address

6983 HILLSDALE CT
INDIANAPOLIS IN
46250-2054
US

V. Phone/Fax

Practice location:
  • Phone: 317-859-1020
  • Fax: 317-859-4040
Mailing address:
  • Phone: 317-849-8350
  • Fax: 317-576-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number01059507A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01059507A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: