Healthcare Provider Details

I. General information

NPI: 1487349007
Provider Name (Legal Business Name): ZACHARY HAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 E WASHINGTON ST STE 300
INDIANAPOLIS IN
46219-5564
US

IV. Provider business mailing address

7910 E WASHINGTON ST STE 300
INDIANAPOLIS IN
46219-5564
US

V. Phone/Fax

Practice location:
  • Phone: 317-891-4704
  • Fax:
Mailing address:
  • Phone: 317-891-4704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01099824A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: