Provider Demographics
NPI:1376626663
Name:BURTEA, ELENA DIANA (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:DIANA
Last Name:BURTEA
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 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11911 N MERIDIAN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6904
Practice Address - Country:US
Practice Address - Phone:317-621-6818
Practice Address - Fax:317-621-4472
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053697A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0000002034OtherANTHEM LEGACY
IN080188177OtherRAILROAD MEDICARE
IN200322580Medicaid
INP01157306OtherRR MEDICARE PTAN
IN200322580Medicaid
IN823720ZZZMedicare PIN
IN148310LMedicare PIN