Provider Demographics
NPI:1023722493
Name:STARUSZKIEWICZ, ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:
Last Name:STARUSZKIEWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15019 CORRAL CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1084
Mailing Address - Country:US
Mailing Address - Phone:317-750-6540
Mailing Address - Fax:
Practice Address - Street 1:15019 CORRAL CT
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1084
Practice Address - Country:US
Practice Address - Phone:317-750-6540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant