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Contact Information

ELAINE M FAN, MD
615 N MICHIGAN ST 4TH FL
SOUTH BEND, IN46601-1033
 Phone: 574-647-6892
 Fax: 574-647-6895
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatric Hematology-Oncology

2080P0207X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for ELAINE M FAN · (Female)

NPI # 1598297178
Status Active
Credentials MD
Entity Individual
Enumeration date 04/01/2017
Last updated 04/22/2026 - About 1 months ago
Sole proprietor 1 No
Identifiers
  • IN License # 01099049A
  • UT License # 11731052-1205
  • IN Medicaid 300128923
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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