Healthcare Provider Details

I. General information

NPI: 1548550692
Provider Name (Legal Business Name): GREGORY ALAN ZILLIGEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 CLEARVISTA PKWY
INDIANAPOLIS IN
46256-5630
US

IV. Provider business mailing address

PO BOX 6005 DEPT 196
INDIANAPOLIS IN
46206-6005
US

V. Phone/Fax

Practice location:
  • Phone: 317-614-9850
  • Fax:
Mailing address:
  • Phone: 317-614-9817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01073439
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: