MEDICARE: ADVANCED ENDOCRINOLOGY AND DIABETES CENTER,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	01045259	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619986379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED ENDOCRINOLOGY AND DIABETES CENTER,

Provider Business Mailing Address
First Line	:	PO BOX 10069
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46411-0069
Country	:	US
Telephone Number	:	219-945-0600
Fax Number	:	219-947-6939

Provider Business Practice Location Address
First Line	:	1600 S LAKE PARK AVE
Second Line	:	SUITE 1104
City	:	HOBART
State	:	IN
Zip	:	46342-6641
Country	:	US
Telephone Number	:	219-945-0600
Fax Number	:	219-947-6939

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/CEO
Name	:	MOHAMED F ZEITOUN
Credential	:	MD
Telephone Number	:	219-945-0600

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	11/24/2020

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