Healthcare Provider Details

I. General information

NPI: 1629072517
Provider Name (Legal Business Name): ROBERT NEIL ELLIOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201
US

IV. Provider business mailing address

411 PLAZA DR SUITE H
COLUMBUS IN
47201-2916
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5974
  • Fax: 812-375-3203
Mailing address:
  • Phone: 812-376-5974
  • Fax: 812-375-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01056931A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01056931A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: