Provider Demographics
NPI:1619406089
Name:SURVANCE, EMILEE JOY (DO)
Entity Type:Individual
Prefix:MS
First Name:EMILEE
Middle Name:JOY
Last Name:SURVANCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S PINE ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2365
Mailing Address - Country:US
Mailing Address - Phone:812-523-5802
Mailing Address - Fax:812-523-5821
Practice Address - Street 1:225 S PINE ST FL 2
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2365
Practice Address - Country:US
Practice Address - Phone:812-523-5802
Practice Address - Fax:812-523-5821
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02006801A207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine