Healthcare Provider Details

I. General information

NPI: 1821004359
Provider Name (Legal Business Name): IBRAHIM SAMIR ZABANEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 45TH ST
MUNSTER IN
46321-3970
US

IV. Provider business mailing address

8416 CRESTWOOD AVE
MUNSTER IN
46321-2012
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1135
  • Fax: 219-836-1157
Mailing address:
  • Phone: 219-670-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01048715A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: