Individual
MR. STEPHEN KIRK DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2675 FOXPOINTE DRIVE, SUITE B, COLUMBUS, IN 47203
(812) 375-0000
(812) 375-0711
Mailing address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 988-2972
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
71001649A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000321795
BLUE CROSS BLUE SHIELD
IN
Enumeration date
01/03/2006
Last updated
01/28/2016
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