Healthcare Provider Details

I. General information

NPI: 1740267533
Provider Name (Legal Business Name): ZIAULLAH VIRK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1908 N MAIN ST STE 120
HAZARD KY
41701-2503
US

IV. Provider business mailing address

PO BOX 959
HAZARD KY
41702-0959
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-2662
  • Fax:
Mailing address:
  • Phone: 606-435-2961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD13689R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number13689R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberN6757
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number48955
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: