Healthcare Provider Details

I. General information

NPI: 1700144953
Provider Name (Legal Business Name): MARC STUART ZIPPER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13521 PROMISE RD
FISHERS IN
46038-7496
US

IV. Provider business mailing address

13521 PROMISE RD
FISHERS IN
46038-7496
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-9898
  • Fax:
Mailing address:
  • Phone: 317-770-9898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02001191A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: