Provider Demographics
NPI:1902287667
Name:LEO, ELAINE (DO, MHA)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:LEO
Suffix:
Gender:F
Credentials:DO, MHA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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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 1:8820 S MERIDIAN ST STE 225
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-6064
Practice Address - Country:US
Practice Address - Phone:317-944-8162
Practice Address - Fax:317-865-6930
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02006610A2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry