Healthcare Provider Details

I. General information

NPI: 1578555496
Provider Name (Legal Business Name): IBRAHIM GEORGE ZABANEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S LAKE PARK AVE STE 500
HOBART IN
46342-6636
US

IV. Provider business mailing address

1400 S LAKE PARK AVE STE 500
HOBART IN
46342-6636
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-7299
  • Fax: 219-947-6624
Mailing address:
  • Phone: 219-942-7299
  • Fax: 219-947-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01033620
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: