Provider Demographics
NPI:1063734382
Name:ZUKAS, ROBERT ANDREW (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ANDREW
Last Name:ZUKAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11846 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2325
Practice Address - Country:US
Practice Address - Phone:317-621-4830
Practice Address - Fax:317-621-4831
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34014015207Q00000X
IN02006982A207Q00000X
NY279514207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04153146Medicaid