Provider Demographics
NPI:1316157290
Name:DATZMAN, ERIN ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:DATZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIN
Other - Middle Name:ELIZABETH
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:416 E MONROE ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-2371
Mailing Address - Country:US
Mailing Address - Phone:574-232-8119
Mailing Address - Fax:574-288-0235
Practice Address - Street 1:416 E MONROE ST
Practice Address - Street 2:STE. 200
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2371
Practice Address - Country:US
Practice Address - Phone:574-232-8119
Practice Address - Fax:574-288-0235
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088539390200000X
IN01068164A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200983620Medicaid