Provider Demographics
NPI:1518566223
Name:ZAICHENKO, DMITRI
Entity Type:Individual
Prefix:
First Name:DMITRI
Middle Name:
Last Name:ZAICHENKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10822 LANTERN VIEW DR APT 307
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4204
Mailing Address - Country:US
Mailing Address - Phone:916-216-4410
Mailing Address - Fax:
Practice Address - Street 1:10822 LANTERN VIEW DR APT 307
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4204
Practice Address - Country:US
Practice Address - Phone:765-400-1401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography