Provider Demographics
NPI:1558340703
Name:ZIAIE, BAHRAM (MD)
Entity Type:Individual
Prefix:MR
First Name:BAHRAM
Middle Name:
Last Name:ZIAIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:BARRY BAHRAM
Other - Middle Name:ZIAIE
Other - Last Name:ARMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 MEDICAL VILLAGE DR.
Mailing Address - Street 2:SUITE 107
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017
Mailing Address - Country:US
Mailing Address - Phone:859-344-8333
Mailing Address - Fax:859-344-0052
Practice Address - Street 1:20 MEDICAL VILLAGE DR.
Practice Address - Street 2:SUITE 107
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-344-8333
Practice Address - Fax:859-344-0052
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY213372084P0800X
OH369452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64213374Medicaid
KY64213374Medicaid