Basic Information
| Provider Information | |||||||||
| NPI: | 1013999341 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIXLEY | ||||||||
| FirstName: | LEE ANN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11109 PARKVIEW PLAZA DR # 117 | ||||||||
| Address2: | |||||||||
| City: | FORT WAYNE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 468451701 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1310 E 7TH ST STE K | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467062518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2609253500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2005 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 01060490A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 45-0513187 | 01 | IN | UNITED HEALTHCARE | OTHER | 0839043 | 05 | OH | MEDICAID | 5518261 | 01 | IN | CIGNA | OTHER | 200521360 | 05 | IN | MEDICAID | 4417545 | 01 | IN | AETNA | OTHER | 18566 | 01 | IN | PHYSICIANS HEALTH PLAN | OTHER |