Provider Demographics
NPI:1669475893
Name:CURTIS, ELIZABETH ANN (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:CURTIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2418 CURTIS DR
Mailing Address - Street 2:STE B
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-8818
Mailing Address - Country:US
Mailing Address - Phone:574-946-7900
Mailing Address - Fax:574-946-7936
Practice Address - Street 1:2418 CURTIS DR
Practice Address - Street 2:STE B
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-8818
Practice Address - Country:US
Practice Address - Phone:574-946-7900
Practice Address - Fax:574-946-7936
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-11-30
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
IN02000870B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000086971OtherBLUE CROSS/BLUE SHIELD
IN670540AMedicare PIN
IN000000086971OtherBLUE CROSS/BLUE SHIELD