Provider Demographics
NPI:1043373780
Name:ZAKI, TARIF IHSAN (CERTIFIED ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:TARIF
Middle Name:IHSAN
Last Name:ZAKI
Suffix:
Gender:M
Credentials:CERTIFIED ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6169 HARBOURSIDE CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2162
Mailing Address - Country:US
Mailing Address - Phone:804-739-4600
Mailing Address - Fax:804-739-1570
Practice Address - Street 1:6169 HARBOURSIDE CENTER LOOP
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2162
Practice Address - Country:US
Practice Address - Phone:804-739-4600
Practice Address - Fax:804-739-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5286280001Medicare ID - Type Unspecified