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General NPI Number Information
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NPI Number | 1154440378
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Entity Type | Organization
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Legal Business Name | ZABANEH MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 1644 45TH AVE
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City | MUNSTER
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State | IN
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Zip | 46321-3970
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Country | US
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Telephone | 219-836-1135
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Fax | 219-836-1157
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Provider Business Mailing Address
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Address Line | 1644 45TH AVE
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City | MUNSTER
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State | IN
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Zip | 46321-3970
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Country | US
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Telephone | 219-836-1135
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Fax | 219-836-1157
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. IBRAHIM SAMIR ZABANEH
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Credential | M.D.
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Telephone | 219-836-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01048715
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License Number State | IN
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