Provider Demographics
NPI:1316626146
Name:ZAKUTANSKY, CHARLES PAUL (FNP-C)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:PAUL
Last Name:ZAKUTANSKY
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:WHEATFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46392-7361
Mailing Address - Country:US
Mailing Address - Phone:219-241-6945
Mailing Address - Fax:
Practice Address - Street 1:9030 CLINE AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2204
Practice Address - Country:US
Practice Address - Phone:219-750-9497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71014116A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F04230288OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
IN28245123AOtherINDIANA NURSING BOARD