Healthcare Provider Details

I. General information

NPI: 1952147951
Provider Name (Legal Business Name): ADAM ZHUANG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W 10TH ST
INDIANAPOLIS IN
46202-3082
US

IV. Provider business mailing address

4665 STONEBRIDGE CT
COLUMBUS IN
47201-4033
US

V. Phone/Fax

Practice location:
  • Phone: 812-344-5140
  • Fax:
Mailing address:
  • Phone: 812-344-5140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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: