1063488765 NPI number — ISAM DIAB MD

Table of content: ISAM DIAB MD (NPI 1063488765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063488765 NPI number — ISAM DIAB MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAB
Provider First Name:
ISAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063488765
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20525 CENTER RIDGE ROAD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
ROCKY RIVER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-895-5056
Provider Business Mailing Address Fax Number:
440-333-2935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18660 BAGLEY ROAD
Provider Second Line Business Practice Location Address:
#102B
Provider Business Practice Location Address City Name:
MIDDLEBURG HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-891-9395
Provider Business Practice Location Address Fax Number:
440-891-1765
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  35059458D , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 341783789049 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 350849 . This is a "WELLCARE MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3200064 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA4511 . This is a "RR MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0786707 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4247166 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0119204 . This is a "GROUP MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3610861 . This is a "ASC GROUP MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: F59458 . This is a "SUMMACARE APEX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000031889 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1780634279 . This is a "GROUP NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: D368301 . This is a "DIAGNOSTIC GROUP MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 102940 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9273172 . This is a "GROUP MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com