MEDICARE: ELZABETH K HARTUP COTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	32001658A	IN

General Provider Information

NPI Number	:	1023349255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELZABETH K HARTUP COTA

Provider Business Mailing Address
First Line	:	8805 EDWARDSBERG PL
Second Line	:
City	:	NEW HAVEN
State	:	IN
Zip	:	46774-1079
Country	:	US
Telephone Number	:	260-246-0048
Fax Number	:

Provider Business Practice Location Address
First Line	:	8805 EDWARDSBERG PL
Second Line	:
City	:	NEW HAVEN
State	:	IN
Zip	:	46774-1079
Country	:	US
Telephone Number	:	260-246-0048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2010
Last Update Date	:	01/28/2010

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