Provider Demographics
NPI:1609036375
Name:ZIETLOW, CHRISTOPHER (MD PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:ZIETLOW
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 W JEFFERSON ST
Mailing Address - Street 2:STE 104
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2731
Mailing Address - Country:US
Mailing Address - Phone:317-834-3263
Mailing Address - Fax:317-834-5194
Practice Address - Street 1:1201 HADLEY RD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1737
Practice Address - Country:US
Practice Address - Phone:317-834-3263
Practice Address - Fax:317-834-5194
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-090815207R00000X
IN01065671A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine