Provider Demographics
NPI:1740223510
Name:GRASEE, ELIZABETH A (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:GRASEE
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:PO BOX 68952
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0952
Mailing Address - Country:US
Mailing Address - Phone:317-802-3158
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:12425 OLD MERIDIAN ST
Practice Address - Street 2:SUITE #B1
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8724
Practice Address - Country:US
Practice Address - Phone:317-581-0001
Practice Address - Fax:317-581-0002
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056343A2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN239560AMedicare PIN
INH75620Medicare UPIN
IN278000DMedicare ID - Type UnspecifiedMEDICARE PROVIDER ID