Provider Demographics
NPI:1114914058
Name:ZENTNER, STEPHAN M (MD)
Entity Type:Individual
Prefix:
First Name:STEPHAN
Middle Name:M
Last Name:ZENTNER
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 1:9795 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-2822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9795 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-2822
Practice Address - Country:US
Practice Address - Phone:317-913-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036195A207Q00000X
MA291967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200306400Medicaid
92638OtherGEISINGER HEALTH PLAN
000000316645OtherANTHEM BLUECROSS/BLUESHIE
92638OtherGEISINGER HEALTH PLAN
000000316645OtherANTHEM BLUECROSS/BLUESHIE