Healthcare Provider Details

I. General information

NPI: 1952452583
Provider Name (Legal Business Name): AMIR ZIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

996 WILKINSON TERRACE SUITE A-7
BOWLING GREEN KY
42103-3408
US

IV. Provider business mailing address

996 WILKINSON TERRACE SUITE A-7
BOWLING GREEN KY
42103-3408
US

V. Phone/Fax

Practice location:
  • Phone: 469-414-0131
  • Fax: 469-839-3005
Mailing address:
  • Phone: 469-414-0131
  • Fax: 469-839-3005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number38494
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number38494
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: