Healthcare Provider Details

I. General information

NPI: 1194707117
Provider Name (Legal Business Name): ENRIQUE EDUARDO INFANTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LAWN AVE SUITE 100
ELKHART IN
46514-2450
US

IV. Provider business mailing address

PO BOX 1887
ELKHART IN
46515-1887
US

V. Phone/Fax

Practice location:
  • Phone: 574-293-2893
  • Fax: 574-293-1298
Mailing address:
  • Phone: 574-389-0542
  • Fax: 574-522-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301084601
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01065587A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: