Provider Demographics
NPI:1467431643
Name:ELEFTHERI, JILL M (PA-C)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:ELEFTHERI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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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:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:SUITE 479
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3050
Practice Address - Country:US
Practice Address - Phone:317-355-1470
Practice Address - Fax:317-355-1475
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000658A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300005113Medicaid
IN000000691734OtherANTHEM
INP01152227OtherRAILROAD MEDICARE
IN000000763624OtherANTHEM
IN000000763624OtherANTHEM
IN300005113Medicaid