Basic Information
| Provider Information | |||||||||
| NPI: | 1043330012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZHANG | ||||||||
| FirstName: | DEKUI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3875 WEST PRESIDENTIAL WAY | ||||||||
| Address2: | SUITE H | ||||||||
| City: | EDINGBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123484000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 17TH ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 472015351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123733024 | ||||||||
| FaxNumber: | 8123760678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 05/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 01064890A | IN | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 000000991121 | 01 | ANTHEM PIN | OTHER | 200953940 | 05 | IN | MEDICAID |