Provider Demographics
NPI:1790783637
Name:MATEOS, ELIZABETH SANCHEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SANCHEZ
Last Name:MATEOS
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 1:390 A ST NE
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:IN
Mailing Address - Zip Code:47441-1822
Mailing Address - Country:US
Mailing Address - Phone:812-699-4023
Mailing Address - Fax:812-699-4084
Practice Address - Street 1:390 A ST NE
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-1822
Practice Address - Country:US
Practice Address - Phone:812-699-4023
Practice Address - Fax:812-699-4084
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033055A207V00000X
IN01033055B207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000084916OtherBCBS
IN100124750AMedicaid
IN160025634OtherRAILROAD MED
IN351519328OtherCOMMERCIAL
IN100124750AMedicaid
IN160025634OtherRAILROAD MED