Provider Demographics
NPI:1376587071
Name:ELLIOTT, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:ELLIOTT
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 1:7340 SHADELAND STA
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3979
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2135
Practice Address - Street 1:7340 SHADELAND STA
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3979
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2135
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023861A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091485OtherANTHEM
IN176500CMedicare PIN
IN176470CMedicare ID - Type Unspecified
IN176640CMedicare PIN
IN000000091485OtherANTHEM
IND94538Medicare UPIN
IN176580CMedicare PIN