Provider Demographics
NPI:1922325836
Name:ZICK, WENDA (MD)
Entity Type:Individual
Prefix:
First Name:WENDA
Middle Name:
Last Name:ZICK
Suffix:
Gender:F
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:LILLY CORPORATE CTR
Mailing Address - Street 2:450 S MADISON AVENUE
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46285-0001
Mailing Address - Country:US
Mailing Address - Phone:317-277-2050
Mailing Address - Fax:
Practice Address - Street 1:5802 HICKORY WOODS DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-8603
Practice Address - Country:US
Practice Address - Phone:317-839-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-02
Last Update Date:2010-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26018671A183500000X
IN01058144A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No183500000XPharmacy Service ProvidersPharmacist