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General NPI Number Information
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NPI Number | 1699003400
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Entity Type | Organization
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Legal Business Name | ZOLLMAN PLASTIC SURGERY
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Dates
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Enumeration Date | 12/07/2009
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Last Update Date | 12/07/2009
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Provider Practice Location Address
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Address Line | 8227 NORTHWEST BLVD SUITE 290
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1387
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Country | US
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Telephone | 317-328-1100
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Fax | 317-334-9228
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Provider Business Mailing Address
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Address Line | 8227 NORTHWEST BLVD SUITE 290
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City | INDIANAPOLIS
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State | IN
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Zip | 46278-1387
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Country | US
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Telephone | 317-328-1100
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Fax | 317-334-9228
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Authorized Official
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Title or Position | OWNER
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Name | MR. CHARLES WALLACE ZOLLMAN
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Credential | MD
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Telephone | 317-328-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 01023513B
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License Number State | IN
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