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NPI Code Detail

MEDICARE: DR. GINA ELISA LAITE M.D.

MEDICARE: DR. GINA ELISA LAITE M.D.
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
12084P0804XChild & Adolescent Psychiatry Physician01037313IN

General Provider Information

NPI Number : 1437263308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GINA ELISA LAITE M.D.
Provider Business Mailing Address
First Line : 3401 E RAYMOND ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-4744
Country : US
Telephone Number : 317-788-9769
Fax Number :
Provider Business Practice Location Address
First Line : 2340 E 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46201-2008
Country : US
Telephone Number : 317-633-7360
Fax Number : 317-633-7302
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 01/16/2012

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