MEDICARE: DR. CARY ZIETLOW M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01042918A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00114711	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000313348	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1013960590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARY ZIETLOW M.D.

Provider Business Mailing Address
First Line	:	45 N MADISON AVE
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-3526
Country	:	US
Telephone Number	:	317-887-7624
Fax Number	:	317-887-7625

Provider Business Practice Location Address
First Line	:	2451 INTELLIPLEX DR
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8580
Country	:	US
Telephone Number	:	317-392-3211
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	12/14/2025

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