Provider Demographics
NPI:1063488765
Name:DIAB, ISAM (MD)
Entity Type:Individual
Prefix:
First Name:ISAM
Middle Name:
Last Name:DIAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20525 CENTER RIDGE ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-895-5056
Mailing Address - Fax:440-333-2935
Practice Address - Street 1:18660 BAGLEY ROAD
Practice Address - Street 2:#102B
Practice Address - City:MIDDLEBURG HTS
Practice Address - State:OH
Practice Address - Zip Code:44130
Practice Address - Country:US
Practice Address - Phone:440-891-9395
Practice Address - Fax:440-891-1765
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35059458D207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
341783789049OtherCARESOURCE
350849OtherWELLCARE MEDICAID
3200064OtherUNITED HEALTHCARE
CA4511OtherRR MEDICARE GROUP
OH0786707Medicaid
OH4247166OtherAETNA
0119204OtherGROUP MEDICAID
OH3610861OtherASC GROUP MEDICARE
F59458OtherSUMMACARE APEX
000000031889OtherANTHEM
1780634279OtherGROUP NPI
OHD368301OtherDIAGNOSTIC GROUP MEDICARE
102940OtherKAISER
OH9273172OtherGROUP MEDICARE
OH9273172OtherGROUP MEDICARE
1780634279OtherGROUP NPI
3200064OtherUNITED HEALTHCARE
E54689Medicare UPIN