Provider Demographics
NPI:1144258732
Name:UNZICKER, ERIC S (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:UNZICKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 W. CR 400 SOUTH
Mailing Address - Street 2:
Mailing Address - City:FARMLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47340
Mailing Address - Country:US
Mailing Address - Phone:765-584-3782
Mailing Address - Fax:
Practice Address - Street 1:905 S WALNUT ST
Practice Address - Street 2:OPEN DOOR CLINIC
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-2333
Practice Address - Country:US
Practice Address - Phone:765-286-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN-38933207Q00000X
IN01062657A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB6728Medicaid
IN200831570Medicaid
NMG49573Medicare UPIN
NM8HZ50SMedicare ID - Type Unspecified
IN466980TMedicare PIN
IN200831570Medicaid