Provider Demographics
NPI:1326038654
Name:YOLLES, ELLIOTT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:A
Last Name:YOLLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W 86TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1969
Mailing Address - Country:US
Mailing Address - Phone:317-872-8772
Mailing Address - Fax:317-872-2383
Practice Address - Street 1:2020 W 86TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1969
Practice Address - Country:US
Practice Address - Phone:317-872-8772
Practice Address - Fax:317-872-2383
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025241207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100057550Medicaid
IN182568540OtherMEDICARE RAILROAD
IN064710Medicare PIN
IN182568540OtherMEDICARE RAILROAD
B28186Medicare UPIN