MEDICARE: ELIZABETH A. MCCALISTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01061739A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00360012	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000481762	OTHER		ANTHEM

General Provider Information

NPI Number	:	1710092689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A. MCCALISTER M.D.

Provider Business Mailing Address
First Line	:	1214 E NATIONAL AVE STE 100
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834-2700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 E NATIONAL AVE STE 100
Second Line	:
City	:	BRAZIL
State	:	IN
Zip	:	47834-2700
Country	:	US
Telephone Number	:	812-442-2820
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/11/2025

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