Provider Demographics
NPI:1013960590
Name:ZIETLOW, CARY (MD)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:
Last Name:ZIETLOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-3526
Mailing Address - Country:US
Mailing Address - Phone:317-887-7624
Mailing Address - Fax:317-887-7625
Practice Address - Street 1:45 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3526
Practice Address - Country:US
Practice Address - Phone:317-887-7624
Practice Address - Fax:317-887-7625
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042918A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000313348OtherANTHEM
INP00114711OtherRR MEDICARE
INP00114711OtherRR MEDICARE