Provider Demographics
NPI:1912946781
Name:STOESZ, ELLEN H (MD)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:H
Last Name:STOESZ
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6820 PARKDALE PL
Practice Address - Street 2:STE 204
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6600
Practice Address - Country:US
Practice Address - Phone:317-944-1000
Practice Address - Fax:317-328-6601
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031921A207R00000X, 207RR0500X
IN01031921207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100330470Medicaid
IN675920EMedicare PIN
INE03853Medicare UPIN
INM400021003Medicare PIN