Provider Demographics
NPI:1518990738
Name:ZWICK, SHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:
Last Name:ZWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHANA
Other - Middle Name:COHEN
Other - Last Name:ZWICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6820 PARKDALE PL STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4699
Practice Address - Country:US
Practice Address - Phone:317-297-7773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062069A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN202141OtherCSHCS
IN000000535672OtherANTHEM
IN000000487658OtherANTHEM (IPA)
IN200862770Medicaid
IN1316128614OtherNPI, IIP GROUP
IN7364860OtherAETNA
IN000000544429OtherANTHEM, IIP
IN1518990738OtherNPI, INDIVIDUAL
IN202141OtherCSHCS