Healthcare Provider Details

I. General information

NPI: 1447670500
Provider Name (Legal Business Name): DEREK ZIPKIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9998 CROSSPOINT BLVD STE 200
INDIANAPOLIS IN
46256-3307
US

IV. Provider business mailing address

9998 CROSSPOINT BLVD STE 200
INDIANAPOLIS IN
46256-3307
US

V. Phone/Fax

Practice location:
  • Phone: 317-579-2150
  • Fax: 317-579-2130
Mailing address:
  • Phone: 317-579-2150
  • Fax: 317-579-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01083430A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: