Provider Demographics
NPI:1982601449
Name:ZALE, DOUGLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:ZALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:711 S CALUMET RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-3220
Mailing Address - Country:US
Mailing Address - Phone:219-926-1001
Mailing Address - Fax:219-929-1989
Practice Address - Street 1:711 S CALUMET RD
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3220
Practice Address - Country:US
Practice Address - Phone:219-926-1001
Practice Address - Fax:219-929-1989
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01036095A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100207650Medicaid
IN6511980BMedicare PIN
IN100207650Medicaid