Provider Demographics
NPI:1255428868
Name:ZEPH, RICHARD D (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:D
Last Name:ZEPH
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 1:13590B N MERIDIAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1406
Mailing Address - Country:US
Mailing Address - Phone:317-573-7887
Mailing Address - Fax:317-573-7535
Practice Address - Street 1:13590B N MERIDIAN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1406
Practice Address - Country:US
Practice Address - Phone:317-573-7887
Practice Address - Fax:317-573-7535
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029850A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100126470BMedicaid
IND94393Medicare UPIN
IN100126470BMedicaid