Healthcare Provider Details

I. General information

NPI: 1912091968
Provider Name (Legal Business Name): ANITA MARY ZACHARIAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 S CALUMET AVENUE
MUNSTER IN
46321-1215
US

IV. Provider business mailing address

7905 S CALUMET AVENUE
MUNSTER IN
46321-1215
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5800
  • Fax: 219-836-8073
Mailing address:
  • Phone: 219-836-5800
  • Fax: 219-836-8073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number044817
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: