Provider Demographics
NPI:1194579789
Name:MPI, ELIZABETH AZUKA
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:AZUKA
Last Name:MPI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 N WHITCOMB AVE APT C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-6732
Mailing Address - Country:US
Mailing Address - Phone:314-688-9431
Mailing Address - Fax:
Practice Address - Street 1:3780 E 39TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-3361
Practice Address - Country:US
Practice Address - Phone:314-688-9431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator