Provider Demographics
NPI:1326091364
Name:ZANETEAS, PHILIP DEAN (PHD, MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:DEAN
Last Name:ZANETEAS
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660264
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46266-0264
Mailing Address - Country:US
Mailing Address - Phone:317-770-0055
Mailing Address - Fax:317-770-0066
Practice Address - Street 1:9240 N MERIDIAN ST
Practice Address - Street 2:SUITE 350
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1880
Practice Address - Country:US
Practice Address - Phone:317-848-0800
Practice Address - Fax:317-848-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200144540Medicaid
IN365760Medicare ID - Type Unspecified
INF10374Medicare UPIN