Provider Demographics
NPI:1053308551
Name:LAUBER, ELIZABETH MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARIE
Last Name:LAUBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 PARK PL
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3520
Mailing Address - Country:US
Mailing Address - Phone:574-335-2521
Mailing Address - Fax:574-335-2262
Practice Address - Street 1:5215 HOLY CROSS PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1469
Practice Address - Country:US
Practice Address - Phone:574-335-2521
Practice Address - Fax:574-335-2262
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01028636A207R00000X
MI4301082777208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000758110OtherBCBS
IN100223240Medicaid
IN3002048OtherOH MEDICAID
INP00632885OtherRAILROAD MEDICARE
IN000000573680OtherANTHEM
IN100223240Medicaid
INM400067607Medicare PIN
IN000000758110OtherBCBS
IN227950A9Medicare ID - Type Unspecified