Provider Demographics
NPI:1710114020
Name:EGLEN, ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:EGLEN
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 1:13121 OLIO RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7425
Mailing Address - Country:US
Mailing Address - Phone:317-621-2462
Mailing Address - Fax:317-621-2475
Practice Address - Street 1:13121 OLIO RD STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7425
Practice Address - Country:US
Practice Address - Phone:317-621-2462
Practice Address - Fax:317-621-2475
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071635A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01424341OtherMEDICARE RR
IN201068240Medicaid
IN266180094Medicare PIN