Individual
DYLAN D COOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, DG 412, INDIANAPOLIS, IN 46202-1239
(317) 962-3886
(317) 962-8652
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01057804A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000366968
ANTHEM
IN
05
—
200068470
—
IN
Enumeration date
08/30/2006
Last updated
03/06/2025
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