Healthcare Provider Details

I. General information

NPI: 1851684823
Provider Name (Legal Business Name): ELIZABETH ELLEN DUGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W 10TH ST M200
INDIANAPOLIS IN
46202-2859
US

IV. Provider business mailing address

1860 PAYSPHERE CIR M200
CHICAGO IL
60674-0018
US

V. Phone/Fax

Practice location:
  • Phone: 317-656-4260
  • Fax: 317-630-2667
Mailing address:
  • Phone: 630-717-2642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036139200
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: