Provider Demographics
NPI:1639691199
Name:BOGENSCHUTZ, ZARA F (PA-C MPAS)
Entity type:Individual
Prefix:
First Name:ZARA
Middle Name:F
Last Name:BOGENSCHUTZ
Suffix:
Gender:
Credentials:PA-C MPAS
Other - Prefix:
Other - First Name:ZARA
Other - Middle Name:F
Other - Last Name:KISIELIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C MPAS
Mailing Address - Street 1:6983 HILLSDALE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2054
Mailing Address - Country:US
Mailing Address - Phone:317-849-8350
Mailing Address - Fax:317-576-6311
Practice Address - Street 1:7250 CLEARVISTA DR STE 225
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5626
Practice Address - Country:US
Practice Address - Phone:317-537-6088
Practice Address - Fax:317-537-6092
Is Sole Proprietor?:No
Enumeration Date:2017-07-16
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10002237A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300017033Medicaid