Healthcare Provider Details

I. General information

NPI: 1902828940
Provider Name (Legal Business Name): NICHOLAS J ZYROMSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N UNIVERSITY BLVD SUITE 1295
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-5012
  • Fax: 317-944-7648
Mailing address:
  • Phone: 317-963-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01061020A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: