Basic Information
| Provider Information | |||||||||
| NPI: | 1932137668 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZEH | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | G. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179623834 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1160 W MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177708555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 11/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 01048750A | IN | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 4977766 | 01 | IN | CIGNA | OTHER | 5279689 | 01 | IN | AETNA | OTHER | 000000561946 | 01 | IN | ANTHEM GRP # | OTHER | 200183410 | 05 | IN | MEDICAID | 50139 | 01 | IN | SIHO | OTHER |