Individual
DR. NICOLE ELOISE MOURILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
901 MACARTHUR BLVD, MUNSTER, IN 46321-2901
(219) 836-4511
(219) 836-7048
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01061467A
IN
207P00000X
Emergency Medicine Physician
Primary
321600
LA
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
036108186
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000531125
ANTHEM BCBS
IN
05
—
036108186
—
IL
05
—
200872480
—
IN
01
—
90001082
BCBS
IL
01
—
P00408759
RAILROAD
IN
Enumeration date
11/30/2005
Last updated
05/20/2024
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