Provider Demographics
NPI:1538112065
Name:EWBANK, ANN S (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:S
Last Name:EWBANK
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 1:8240 NAAB RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1950
Mailing Address - Country:US
Mailing Address - Phone:317-338-7902
Mailing Address - Fax:317-338-7949
Practice Address - Street 1:8240 NAAB RD
Practice Address - Street 2:SUITE 220
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1950
Practice Address - Country:US
Practice Address - Phone:317-338-7902
Practice Address - Fax:317-338-7949
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059606A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200802200Medicaid
IN898230HMedicare PIN
INM400015012Medicare PIN