Provider Demographics
NPI:1073714549
Name:ZHAO, ZHIQUAN (MD)
Entity Type:Individual
Prefix:
First Name:ZHIQUAN
Middle Name:
Last Name:ZHAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-251-2100
Mailing Address - Fax:574-251-2150
Practice Address - Street 1:6301 UNIVERSITY COMMONS STE 310
Practice Address - Street 2:OB/GYN OFFICE
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1479
Practice Address - Country:US
Practice Address - Phone:574-232-1471
Practice Address - Fax:574-232-0741
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT050379207V00000X, 207VG0400X
IN01075003A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201279260Medicaid
IN000000934242OtherBCBS HOSP
CT1073714549Medicaid
IN000000934270OtherBCBS FMC
CT1073714549Medicaid