Individual
ELIZABETH V MATHEWS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4880 CENTURY PLAZA RD STE 250, INDIANAPOLIS, IN 46254-5471
(317) 216-2500
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
02006795A
IN
208000000X
Pediatrics Physician
125.073992
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430E99
MEDICARE PTAN
IN
05
—
300063148
—
IN
Enumeration date
03/26/2019
Last updated
04/15/2024
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