Provider Demographics
NPI:1154647220
Name:ROUSE, CAROLINE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELIZABETH
Last Name:ROUSE
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 1:550 N. UNIVERSITY BOULEVARD, UH 2440
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-944-8182
Mailing Address - Fax:317-944-7417
Practice Address - Street 1:550 N. UNIVERSITY BOULEVARD, UH 2440
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-0001
Practice Address - Country:US
Practice Address - Phone:317-944-8182
Practice Address - Fax:317-944-7417
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60156663207V00000X
IN01078682A207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300005054Medicaid
IN896330036OtherMEDICARE PTAN