Healthcare Provider Details

I. General information

NPI: 1740979624
Provider Name (Legal Business Name): ZUBAIR COSMETIC GYNECOLOGY AND MEDSPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9410 CALUMET AVENUE SUITE 104
MUNSTER IN
46321
US

IV. Provider business mailing address

9030 COLUMBIA AVE STE D
MUNSTER IN
46321-2905
US

V. Phone/Fax

Practice location:
  • Phone: 219-440-2505
  • Fax:
Mailing address:
  • Phone: 217-791-9737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE ZUBAIR
Title or Position: OWNER
Credential: MD
Phone: 217-791-9737