Provider Demographics
NPI:1962472159
Name:ALI, ZEBA (MD)
Entity Type:Individual
Prefix:
First Name:ZEBA
Middle Name:
Last Name:ALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 COLUMBIA AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2600
Mailing Address - Country:US
Mailing Address - Phone:219-836-2730
Mailing Address - Fax:219-836-0244
Practice Address - Street 1:9128 COLUMBIA AVE
Practice Address - Street 2:STE A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2600
Practice Address - Country:US
Practice Address - Phone:219-836-2730
Practice Address - Fax:219-836-0244
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01060503A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200525380Medicaid
I36509Medicare UPIN
IN200525380Medicaid