Individual
ZACHARY R JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6925 E 96TH ST STE 150, INDIANAPOLIS, IN 46250-3648
(317) 621-6925
(317) 621-6950
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01088745A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
068010903
MEDICARE PTAN
IN
01
—
264430H48
MEDICARE PTAN
IN
05
—
300079834
—
IN
Enumeration date
05/07/2019
Last updated
05/14/2025
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