Provider Demographics
NPI:1366623381
Name:OZIMEK, MATTHEW W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:W
Last Name:OZIMEK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD
Mailing Address - Street 2:SUITE 755
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-923-1787
Mailing Address - Fax:317-962-6259
Practice Address - Street 1:1801 N. SENATE BLVD.
Practice Address - Street 2:SUITE 755
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1260
Practice Address - Country:US
Practice Address - Phone:317-923-1787
Practice Address - Fax:317-962-6259
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002707363AM0700X
IN10001060A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOZPA29961OtherMEDICARE PTAN
IN300026718Medicaid