Healthcare Provider Details

I. General information

NPI: 1477553501
Provider Name (Legal Business Name): HENRY M. ZUNIGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD
NEWBURGH IN
47630-8940
US

IV. Provider business mailing address

PO BOX 3415
MUNSTER IN
46321-0415
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-4200
  • Fax:
Mailing address:
  • Phone: 219-836-0000
  • Fax: 219-836-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01049865A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: