Provider Demographics
NPI:1467663674
Name:RIAD ZAKY, WAHID ALFONSE (MD)
Entity Type:Individual
Prefix:DR
First Name:WAHID
Middle Name:ALFONSE
Last Name:RIAD ZAKY
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 1:905 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-4407
Mailing Address - Country:US
Mailing Address - Phone:319-874-3000
Mailing Address - Fax:319-874-3411
Practice Address - Street 1:905 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4407
Practice Address - Country:US
Practice Address - Phone:319-272-4300
Practice Address - Fax:319-272-4411
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089444207QH0002X
IA37186207QH0002X, 207Q00000X
PAMT184001207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0076372Medicaid