Provider Demographics
NPI:1063460319
Name:PHIPPS, ERIN J (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:J
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ERIN
Other - Middle Name:J
Other - Last Name:STEPHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5515 W 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2919
Practice Address - Country:US
Practice Address - Phone:317-880-3838
Practice Address - Fax:317-880-0081
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058965A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200478520Medicaid
INI17976Medicare UPIN
IN715530W9Medicare PIN
ININ1768046Medicare PIN
IN200478520Medicaid