Healthcare Provider Details

I. General information

NPI: 1093753063
Provider Name (Legal Business Name): ZIAD W. DEEB SARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3229 SUMMIT SQUARE PL SUITE 240
LEXINGTON KY
40509-2648
US

IV. Provider business mailing address

PO BOX 1430
FRANKFORT KY
40602-1430
US

V. Phone/Fax

Practice location:
  • Phone: 502-867-0411
  • Fax: 502-867-0453
Mailing address:
  • Phone: 502-226-3858
  • Fax: 502-223-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number36332
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: