Provider Demographics
NPI:1518908466
Name:ZELLEM, RONALD T (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:T
Last Name:ZELLEM
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 1:242 W. MAIN SREET
Mailing Address - Street 2:#233
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075
Mailing Address - Country:US
Mailing Address - Phone:615-944-3053
Mailing Address - Fax:615-822-8032
Practice Address - Street 1:119 HIDDEN PT
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075
Practice Address - Country:US
Practice Address - Phone:615-944-3053
Practice Address - Fax:615-822-8032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036126939207T00000X
TN20953207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3726268Medicaid
IL208905108Medicare PIN
TNB40640Medicare UPIN
TN3726268Medicaid
TN3053733Medicare ID - Type Unspecified