Healthcare Provider Details

I. General information

NPI: 1760947329
Provider Name (Legal Business Name): ELLEN MARGARET KRESCA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN MARGARET RANDALL

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR STE 2514
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-0345
  • Fax: 317-948-0939
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10002625A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: