Healthcare Provider Details

I. General information

NPI: 1265978043
Provider Name (Legal Business Name): CHILDRENS & FAMILY MEDICINE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9128 COLUMBIA AVE STE A
MUNSTER IN
46321-2547
US

IV. Provider business mailing address

9128 COLUMBIA AVE STE A
MUNSTER IN
46321-2547
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2730
  • Fax: 219-836-0244
Mailing address:
  • Phone: 219-836-2730
  • Fax: 219-836-0244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. ZEBA ALI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 734-272-3448