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Individual

ELAINE M. FAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
615 N MICHIGAN ST 4TH FL, SOUTH BEND, IN 46601-1033
(574) 647-6892
(574) 647-6895
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-3725

Taxonomy

Speciality
Code
Description
License number
State
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
01099049A
IN
2080P0207X
Pediatric Hematology & Oncology Physician
11731052-1205
UT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300128923
IN
Enumeration date
04/01/2017
Last updated
04/22/2026
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