Individual
LIZA L ILAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
720 ESKENAZI AVE, INDIANAPOLIS, IN 46202-5187
(317) 630-6662
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01061472A
IN
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01061472A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001024674
ANTHEM PTAN
IN
01
—
1102395240
ANTHEM PTAN
IN
05
—
201362850
—
IN
Enumeration date
12/01/2006
Last updated
03/10/2025
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