Healthcare Provider Details

I. General information

NPI: 1902648249
Provider Name (Legal Business Name): ELIZABETH PICH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 E 10TH ST
INDIANAPOLIS IN
46201-2100
US

IV. Provider business mailing address

3908 MEADOWS DR STE C
INDIANAPOLIS IN
46205-3114
US

V. Phone/Fax

Practice location:
  • Phone: 317-957-2200
  • Fax:
Mailing address:
  • Phone: 317-957-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: