Healthcare Provider Details

I. General information

NPI: 1033581962
Provider Name (Legal Business Name): NORTHWEST INDIANA MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 03/07/2016
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: 219-836-1152
  • Fax: 219-513-9162
Mailing address:
  • Phone: 219-836-1152
  • Fax: 219-513-9162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: IBRAHIM ZABANEH
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 219-836-1152