MEDICARE: DR. ELLEN B MARCUS 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	207Q00000X	Family Medicine Physician	01041298A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730147687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLEN B MARCUS MD

Provider Business Mailing Address
First Line	:	5214 WOODSIDE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-2302
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5214 WOODSIDE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-2302
Country	:	US
Telephone Number	:	317-254-0844
Fax Number	:

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	07/16/2012

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