Individual
CARLEIGH ELISSA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02002914A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001077943
ANTHEM PROVIDER NUMBER
IN
05
—
200524580
—
IN
Enumeration date
04/04/2006
Last updated
02/23/2021
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