Provider Demographics
NPI:1821004359
Name:ZABANEH, IBRAHIM SAMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:IBRAHIM
Middle Name:SAMIR
Last Name:ZABANEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:2150 GETTLER ST STE 260
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2381
Practice Address - Country:US
Practice Address - Phone:219-864-2626
Practice Address - Fax:219-864-2627
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048715A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200200450Medicaid
IN200200450AMedicaid
IN090810Medicare ID - Type Unspecified