Provider Demographics
NPI:1962473694
Name:ERMITANO, MARIA LUISA PILAR DEBUQUE (MD)
Entity Type:Individual
Prefix:
First Name:MARIA LUISA PILAR
Middle Name:DEBUQUE
Last Name:ERMITANO
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 1:8150 OAKLANDON RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9525
Mailing Address - Country:US
Mailing Address - Phone:317-826-5440
Mailing Address - Fax:317-826-5463
Practice Address - Street 1:8150 OAKLANDON RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9525
Practice Address - Country:US
Practice Address - Phone:317-826-5440
Practice Address - Fax:317-826-5463
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061785A207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INH27416Medicare UPIN