Provider Demographics
NPI:1053541169
Name:COTTONGIM, ELIZABETH S (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:COTTONGIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13420 N MERIDIAN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1581
Mailing Address - Country:US
Mailing Address - Phone:317-573-7050
Mailing Address - Fax:317-573-7098
Practice Address - Street 1:13420 N MERIDIAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1581
Practice Address - Country:US
Practice Address - Phone:317-573-7050
Practice Address - Fax:317-573-7098
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01072150A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201162500Medicaid
IN677690006Medicare PIN