Provider Demographics
NPI:1780704114
Name:ZABANEH MEDICAL CORPORATION
Entity type:Organization
Organization Name:ZABANEH MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:SAMIR
Authorized Official - Last Name:ZABANEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-736-8888
Mailing Address - Street 1:8550 BROADWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-736-8888
Mailing Address - Fax:219-736-0450
Practice Address - Street 1:8550 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7032
Practice Address - Country:US
Practice Address - Phone:219-736-8888
Practice Address - Fax:219-736-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty