Healthcare Provider Details

I. General information

NPI: 1174842595
Provider Name (Legal Business Name): ANNE ELIZABETH MATTINGLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL LN STE 315
DANVILLE IN
46122-1993
US

IV. Provider business mailing address

1100 SOUTHFIELD DR STE 1370
PLAINFIELD IN
46168-4300
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-9000
  • Fax: 317-718-9010
Mailing address:
  • Phone: 317-837-5570
  • Fax: 317-837-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number01076886A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01076886A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: