Individual
DR. DIANE ELIZABETH ELROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3266 N MERIDIAN STREET, STE 101, INDIANAPOLIS, IN 46208-5859
(317) 925-0653
(317) 925-0774
Mailing address
3266 N MERIDIAN STREET, STE 101, INDIANAPOLIS, IN 46208-5859
(317) 925-0653
(317) 925-0774
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
02001479A
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
02001479A
IN
208D00000X
General Practice Physician
02001479A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200088580
—
IN
01
—
380210001
MEDICARE
IN
Enumeration date
01/31/2008
Last updated
12/11/2015
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