Healthcare Provider Details

I. General information

NPI: 1609876861
Provider Name (Legal Business Name): JACK H ZIEGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 09/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S LAKE PARK AVE SUITE 1400
HOBART IN
46342-6636
US

IV. Provider business mailing address

1400 S LAKE PARK AVE SUITE 1400
HOBART IN
46342-6636
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-6166
  • Fax: 219-942-4106
Mailing address:
  • Phone: 219-942-6166
  • Fax: 219-942-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01031712A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: