Provider Demographics
NPI:1023010782
Name:ZIAEI, POUPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:POUPAK
Middle Name:
Last Name:ZIAEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2641 W HORIZON RIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4836
Mailing Address - Country:US
Mailing Address - Phone:702-616-0091
Mailing Address - Fax:702-616-2329
Practice Address - Street 1:2641 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4836
Practice Address - Country:US
Practice Address - Phone:702-616-0091
Practice Address - Fax:702-616-2329
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-112460207R00000X
NV12525207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-112460-1Medicaid
IL036-112460-1Medicaid
H90261Medicare UPIN