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Indiana Professional Licensing Agency

PLA > Professions > Medical Licensing Board of Indiana > Name Changes Name Changes

You may change your name on your medical license by faxing or mailing a legal document to our office. Acceptable documents are a marriage certificate, divorce decree, court document changing name. You may still renew online if you have a name change. Please send us the documentation and allow for one week to receive and process your change. You may then go online to renew and your pocket card should be issued in your new name.

Contact Information
Indiana Professional Licensing Agency
Attn: Medical Licensing Board
402 West Washington Street, Room W072
Indianapolis, IN 46204

Fax (317) 233-4236
Phone (317) 234-2060