Healthcare Provider Details

I. General information

NPI: 1790783637
Provider Name (Legal Business Name): ELIZABETH SANCHEZ MATEOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 A ST NE
LINTON IN
47441-1822
US

IV. Provider business mailing address

390 A ST NE
LINTON IN
47441-1822
US

V. Phone/Fax

Practice location:
  • Phone: 812-699-4023
  • Fax: 812-699-4084
Mailing address:
  • Phone: 812-699-4023
  • Fax: 812-699-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01033055A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01033055B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: