MEDICARE: ELYSIAN PRIMARY CARE LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1609732510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELYSIAN PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	6213 ROYAL GATE PL
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46237-9273
Country	:	US
Telephone Number	:	317-245-6193
Fax Number	:

Provider Business Practice Location Address
First Line	:	6280 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4389
Country	:	US
Telephone Number	:	317-245-6193
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SARABJOT KAUR
Credential	:
Telephone Number	:	317-245-6193

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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