Provider Demographics
NPI:1770583635
Name:ENGLERT, JUDITH ANN (MD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:ENGLERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9053
Mailing Address - Country:US
Mailing Address - Phone:812-482-6424
Mailing Address - Fax:812-634-9701
Practice Address - Street 1:200 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9053
Practice Address - Country:US
Practice Address - Phone:812-482-6424
Practice Address - Fax:812-634-9701
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050488207WX0110X
IN01050488A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200236290AMedicaid
INH01409Medicare UPIN
IN200236290AMedicaid
IN534080FMedicare ID - Type Unspecified
IN213760Medicare PIN