Provider Demographics
NPI:1518913524
Name:SAKYIAMA, EZEKIEL (MD)
Entity Type:Individual
Prefix:
First Name:EZEKIEL
Middle Name:
Last Name:SAKYIAMA
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 1:2101 KIMBALL AVE
Mailing Address - Street 2:LL14
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-5063
Mailing Address - Country:US
Mailing Address - Phone:319-272-1590
Mailing Address - Fax:319-272-1535
Practice Address - Street 1:516 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2382
Practice Address - Country:US
Practice Address - Phone:319-268-3550
Practice Address - Fax:319-268-3855
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35288207R00000X
IL036-123415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0419986Medicaid
IAI10821Medicare PIN
IAH97627Medicare UPIN