Basic Information
| Provider Information | |||||||||
| NPI: | 1083131957 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ZILMED LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2476 CANTON RD | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300665377 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022449859 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 VISSING PARK RD | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471305989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5022449859 | ||||||||
| FaxNumber: | 7705739513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2017 | ||||||||
| LastUpdateDate: | 12/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHETH | ||||||||
| AuthorizedOfficialFirstName: | JAYESH | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5022449859 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/30/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.