Provider Demographics
NPI:1184651499
Name:ALLIED FAMILY MEDICINE
Entity type:Organization
Organization Name:ALLIED FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIBOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-968-2500
Mailing Address - Street 1:PO BOX 6219
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46660-6219
Mailing Address - Country:US
Mailing Address - Phone:574-255-1522
Mailing Address - Fax:574-255-1540
Practice Address - Street 1:314 W CATALPA DR
Practice Address - Street 2:SUITE A
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3194
Practice Address - Country:US
Practice Address - Phone:574-255-1522
Practice Address - Fax:574-255-1540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200542230BMedicaid
IN1184651499OtherANTHEM BLUE CROSS BLUE SHIELD
ING16171Medicare UPIN
IN233430Medicare ID - Type Unspecified