Individual
MARIA ELISABETH FAASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-4145
(574) 335-4146
Mailing address
707 CEDAR ST STE 405, SOUTH BEND, IN 46617-2059
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
01072165
IN
2080N0001X
Neonatal-Perinatal Medicine Physician
038145
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000859438
BCBS
IN
01
—
000000925186
BCBS NICU
IN
05
—
00685913H
—
GA
01
—
038145
GA LICENSE NUMBER
GA
05
—
201222680
—
IN
Enumeration date
10/04/2006
Last updated
07/06/2023
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