MEDICARE: DR. PETER S COONEY 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 Physician	01036846A	IN

General Provider Information

NPI Number	:	1821070814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER S COONEY MD

Provider Business Mailing Address
First Line	:	2050 W 56TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-1702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 W 56TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-1702
Country	:	US
Telephone Number	:	317-989-3438
Fax Number	:

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

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	03/01/2016

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