Provider Demographics
NPI:1942297627
Name:TAKACS, ZSOLT SHEPHERD (MD)
Entity Type:Individual
Prefix:DR
First Name:ZSOLT
Middle Name:SHEPHERD
Last Name:TAKACS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 N LEBANON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-8612
Mailing Address - Country:US
Mailing Address - Phone:765-485-8649
Mailing Address - Fax:765-485-8650
Practice Address - Street 1:2705 N LEBANON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-8612
Practice Address - Country:US
Practice Address - Phone:765-485-8649
Practice Address - Fax:765-485-8650
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044179207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200127050AMedicaid
IN200127050AMedicaid
ING50300Medicare UPIN