Healthcare Provider Details

I. General information

NPI: 1770532699
Provider Name (Legal Business Name): M NABIL SHABEEB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9050 COLUMBIA AVE
MUNSTER IN
46321-2905
US

IV. Provider business mailing address

9050 COLUMBIA AVE
MUNSTER IN
46321-2905
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-9800
  • Fax: 219-836-9300
Mailing address:
  • Phone: 219-836-9800
  • Fax: 219-836-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01033392A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: