Healthcare Provider Details

I. General information

NPI: 1861301467
Provider Name (Legal Business Name): LUKE ELY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE BLVD
INDIANAPOLIS IN
46202-1239
US

IV. Provider business mailing address

5220 W STONE WAY
NEW PALESTINE IN
46163-9471
US

V. Phone/Fax

Practice location:
  • Phone: 317-509-9747
  • Fax:
Mailing address:
  • Phone: 317-509-9747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: