Healthcare Provider Details

I. General information

NPI: 1669475893
Provider Name (Legal Business Name): ELIZABETH ANN CURTIS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

2418 CURTIS DR STE B
WINAMAC IN
46996-8818
US

IV. Provider business mailing address

2418 CURTIS DR STE B
WINAMAC IN
46996-8818
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-7900
  • Fax: 574-946-7936
Mailing address:
  • Phone: 574-946-7900
  • Fax: 574-946-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000870B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: