Provider Demographics
NPI:1275560583
Name:ZIBOH, MAUREEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:ZIBOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69045 M 62 STE B
Mailing Address - Street 2:
Mailing Address - City:EDWARDSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49112-9168
Mailing Address - Country:US
Mailing Address - Phone:574-968-4100
Mailing Address - Fax:574-968-4125
Practice Address - Street 1:69045 M 62 STE B
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9168
Practice Address - Country:US
Practice Address - Phone:574-968-4100
Practice Address - Fax:574-968-4125
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045545A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200046830AMedicaid
IN000000532035OtherANTHEM
IN200046830Medicaid
IN200046830AMedicaid
ING16171Medicare UPIN
ININ1050002Medicare PIN