Healthcare Provider Details

I. General information

NPI: 1063734382
Provider Name (Legal Business Name): ROBERT ANDREW ZUKAS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 10/10/2022
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11846 LAKESIDE DR
FISHERS IN
46038-2325
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-4830
  • Fax: 317-621-4831
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34014015
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02006982A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number279514
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: