Healthcare Provider Details

I. General information

NPI: 1023722493
Provider Name (Legal Business Name): MISS ELIZABETH STARUSZKIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N FORD RD
ZIONSVILLE IN
46077-1233
US

IV. Provider business mailing address

15019 CORRAL CT
CARMEL IN
46032-1084
US

V. Phone/Fax

Practice location:
  • Phone: 317-973-3333
  • Fax: 317-973-3330
Mailing address:
  • Phone: 317-750-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10004940A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: