Individual
ELLEN FAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6002 E 38TH ST, INDIANAPOLIS, IN 46226-5614
(317) 880-6002
(317) 880-0417
Mailing address
PO BOX 637764, CINCINNATI, OH 45263-7764
(317) 880-3939
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01063338A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000541927
ANTHEM
IN
05
—
200876690
—
IN
Enumeration date
06/12/2007
Last updated
09/16/2025
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