Provider Demographics
NPI:1699003400
Name:ZOLLMAN PLASTIC SURGERY
Entity Type:Organization
Organization Name:ZOLLMAN PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:ZOLLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-328-1100
Mailing Address - Street 1:8227 NORTHWEST BLVD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1387
Mailing Address - Country:US
Mailing Address - Phone:317-328-1100
Mailing Address - Fax:317-334-9228
Practice Address - Street 1:8227 NORTHWEST BLVD
Practice Address - Street 2:SUITE 290
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1387
Practice Address - Country:US
Practice Address - Phone:317-328-1100
Practice Address - Fax:317-334-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023513B2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty