Provider Demographics
NPI:1104120104
Name:ZORMEIER COSMETIC SURGERY AND LONGEVITY CENTER, LLC
Entity type:Organization
Organization Name:ZORMEIER COSMETIC SURGERY AND LONGEVITY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZORMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-392-6200
Mailing Address - Street 1:302 DURAN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1986
Mailing Address - Country:US
Mailing Address - Phone:317-392-6200
Mailing Address - Fax:317-398-7526
Practice Address - Street 1:302 DURAN DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1986
Practice Address - Country:US
Practice Address - Phone:317-392-6200
Practice Address - Fax:317-398-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050761A207YX0007X, 207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty