Provider Demographics
NPI:1194707117
Name:INFANTE, ENRIQUE EDUARDO (MD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:EDUARDO
Last Name:INFANTE
Suffix:
Gender:M
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:PO BOX 1887
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46515-1887
Mailing Address - Country:US
Mailing Address - Phone:574-389-0542
Mailing Address - Fax:574-522-8505
Practice Address - Street 1:1215 LAWN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2450
Practice Address - Country:US
Practice Address - Phone:574-293-2893
Practice Address - Fax:574-293-1298
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301084601207V00000X
IN01065587A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200908830Medicaid
IN000000573936OtherBCBS
IN000000702255OtherANTHEM - WCCC
IN200908830Medicaid
IN000000702255OtherANTHEM - WCCC
INP00933636Medicare PIN
IN250820EMedicare PIN