MEDICARE: ISAM DIAB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	35059458D	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CA4511	OTHER		RR MEDICARE GROUP
8	3610861	OTHER	OH	ASC GROUP MEDICARE
12	D368301	OTHER	OH	DIAGNOSTIC GROUP MEDICARE
14	9273172	OTHER	OH	GROUP MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	341783789049	OTHER		CARESOURCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3200064	OTHER		UNITED HEALTHCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	4247166	OTHER	OH	AETNA
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	F59458	OTHER		SUMMACARE APEX
10	000000031889	OTHER		ANTHEM
11	1780634279	OTHER		GROUP NPI
13	102940	OTHER		KAISER

General Provider Information

NPI Number	:	1063488765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAM DIAB MD

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

Provider Business Practice Location Address
First Line	:	18660 BAGLEY ROAD
Second Line	:	#102B
City	:	MIDDLEBURG HTS
State	:	OH
Zip	:	44130
Country	:	US
Telephone Number	:	440-891-9395
Fax Number	:	440-891-1765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	05/27/2008

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Directions to “ ISAM DIAB MD” Practice Location

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