Healthcare Provider Details

I. General information

NPI: 1154440378
Provider Name (Legal Business Name): ZABANEH MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 45TH AVE
MUNSTER IN
46321-3970
US

IV. Provider business mailing address

1644 45TH AVE
MUNSTER IN
46321-3970
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1135
  • Fax: 219-836-1157
Mailing address:
  • Phone: 219-836-1135
  • Fax: 219-836-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01048715
License Number StateIN

VIII. Authorized Official

Name: DR. IBRAHIM SAMIR ZABANEH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-836-1135