Provider Demographics
NPI:1528485018
Name:PHILIP ZANETEAS, PHD, MD, INC., PC
Entity type:Organization
Organization Name:PHILIP ZANETEAS, PHD, MD, INC., PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANETEAS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:317-848-0800
Mailing Address - Street 1:9240 N MERIDIAN ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1880
Mailing Address - Country:US
Mailing Address - Phone:317-848-0800
Mailing Address - Fax:317-848-0804
Practice Address - Street 1:9240 N MERIDIAN ST
Practice Address - Street 2:SUITE 350
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1880
Practice Address - Country:US
Practice Address - Phone:317-848-0800
Practice Address - Fax:317-848-0804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003491A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1326091364OtherPHYSICIAN NPI
IN276162700OtherU.S. DEPARTMENT OF LABOR
IN50003491AOtherINDIANA CORPORATE MEDICAL LICENSE
IN01040424AOtherINDIANA PHYSICIAN MEDICAL LICENSE
IN200144540AMedicaid
IN01040424AOtherINDIANA PHYSICIAN MEDICAL LICENSE
IN276162700OtherU.S. DEPARTMENT OF LABOR