Provider Demographics
NPI:1194128496
Name:ANKENMAN, ELIZABETH LUCILLE (MD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LUCILLE
Last Name:ANKENMAN
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 1:31 W ELM ST
Mailing Address - Street 2:P.O. BOX 5
Mailing Address - City:CEDARVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45314-8594
Mailing Address - Country:US
Mailing Address - Phone:937-766-5683
Mailing Address - Fax:937-766-3075
Practice Address - Street 1:31 W ELM ST
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-8594
Practice Address - Country:US
Practice Address - Phone:937-766-5683
Practice Address - Fax:937-766-3075
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.023636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine