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Individual

STEPHEN JAMES CARLSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7950 N SHADELAND AVENUE, SUITE 350, INDIANAPOLIS, IN 46250
(317) 578-2600
(317) 578-6474
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01049970A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000793461
ANTHEM
IN
05
200072620
IN
05
200072620A
IN
01
P01170501
RR MEDICARE PTAN
IN
Enumeration date
03/08/2006
Last updated
11/27/2023
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