Provider Demographics
NPI:1144422502
Name:ZAKARIA, MHD TAREK (MD)
Entity Type:Individual
Prefix:
First Name:MHD TAREK
Middle Name:
Last Name:ZAKARIA
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 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:1150 N 35TH AVE STE 590
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-265-9500
Practice Address - Fax:954-265-1431
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1176362084N0400X, 2084N0400X
MN513122084N0400X
KY433402084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010223800Medicaid
KY000052153MOtherHUMANA - NNS
KY50029464OtherPASSPORT & PP ADVTG - NNS
FLHS159ZOtherMEDICARE PTAN
MNP00838990OtherMEDICARE, RAILROAD
FL010223800Medicaid
KY116238OtherSIHO - NNS
KY7100155640Medicaid
KY9543674OtherCIGNA - NNS
MNENROLLEDMedicaid
KYP00861076OtherMEDICARE RAILROAD
KY000000668065OtherANTHEM - NNS
FL010223800Medicaid
MN130001407Medicare PIN