Healthcare Provider Details

I. General information

NPI: 1255348371
Provider Name (Legal Business Name): OLEH DZERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HARCOURT RD
INDIANAPOLIS IN
46260-2036
US

IV. Provider business mailing address

8401 HARCOURT RD
INDIANAPOLIS IN
46260-2036
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01034981A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: