Healthcare Provider Details

I. General information

NPI: 1306649769
Provider Name (Legal Business Name): NASSER DEAN ZBEEB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 CAREW ST
FORT WAYNE IN
46805-4713
US

IV. Provider business mailing address

2200 RANDALLIA DR
FORT WAYNE IN
46805-4638
US

V. Phone/Fax

Practice location:
  • Phone: 260-373-7765
  • Fax:
Mailing address:
  • Phone: 260-373-7765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11024540A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: