MEDICARE: JAMES W, EHLICH JR. MD

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	207R00000X	Internal Medicine Physician	01036561A	IN
2	207RR0500X	Rheumatology Physician	01036561A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000538180	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225010887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES W, EHLICH JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	5255 E STOP 11 RD STE 320
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-6341
Country	:	US
Telephone Number	:	317-888-1467
Fax Number	:	317-888-1476

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	06/05/2023

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