Individual
DR. TIMOTHY J ELLENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(888) 484-3258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01059432
IN
207P00000X
Emergency Medicine Physician
Primary
01059432A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01059432A
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200841330
—
IN
01
—
P00920827
RAILROAD MEDICARE PIN
IN
Enumeration date
07/29/2006
Last updated
03/10/2025
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