Provider Demographics
NPI:1659537785
Name:TAYEB, ZEESHAN KHALICK (MD)
Entity Type:Individual
Prefix:
First Name:ZEESHAN
Middle Name:KHALICK
Last Name:TAYEB
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 1:3328 WESTBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-5133
Mailing Address - Country:US
Mailing Address - Phone:513-922-2204
Mailing Address - Fax:513-922-2009
Practice Address - Street 1:3328 WESTBOURNE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-5133
Practice Address - Country:US
Practice Address - Phone:513-624-7246
Practice Address - Fax:513-624-6900
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0885182081P2900X
KY441512081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200982410Medicaid
OH3004493Medicaid
KY7100103970Medicaid
KYK030381Medicare PIN
IN200982410Medicaid
OH4280401Medicare PIN
KY7100103970Medicaid
OHP00952494Medicare PIN