Individual
DR. JEREMIAH ELLINGSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1002 WISHARD BLVD STE 4016, INDIANAPOLIS, IN 46202-4164
(317) 274-6450
Mailing address
1002 WISHARD BLVD STE 4016, INDIANAPOLIS, IN 46202-4164
(317) 274-6450
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
02006805A
IN
2084P0800X
Psychiatry Physician
T-3765
MS
Other
Enumeration date
04/11/2019
Last updated
06/28/2022
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