Provider Demographics
NPI:1083396659
Name:AHMAD AZIZY, ZEKRIA
Entity Type:Individual
Prefix:
First Name:ZEKRIA
Middle Name:
Last Name:AHMAD AZIZY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3503 N SUMMERPARK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5590
Mailing Address - Country:US
Mailing Address - Phone:208-713-4313
Mailing Address - Fax:
Practice Address - Street 1:3503 N SUMMERPARK AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5590
Practice Address - Country:US
Practice Address - Phone:208-713-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company