Provider Demographics
NPI:1093753063
Name:DEEB SARA, ZIAD W (MD)
Entity Type:Individual
Prefix:
First Name:ZIAD
Middle Name:W
Last Name:DEEB SARA
Suffix:
Gender:M
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40602-1430
Mailing Address - Country:US
Mailing Address - Phone:502-226-3858
Mailing Address - Fax:502-223-9829
Practice Address - Street 1:3229 SUMMIT SQUARE PL
Practice Address - Street 2:SUITE 240
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2648
Practice Address - Country:US
Practice Address - Phone:502-867-0411
Practice Address - Fax:502-867-0453
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36332207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000493306OtherANTHEM BCBS
KY64062557Medicaid
000000493306OtherANTHEM BCBS
KY64062557Medicaid