Provider Demographics
NPI:1952452583
Name:ZIA, AMIR (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:ZIA
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 1:523 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1765
Mailing Address - Country:US
Mailing Address - Phone:270-393-8418
Mailing Address - Fax:270-393-8440
Practice Address - Street 1:523 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1765
Practice Address - Country:US
Practice Address - Phone:270-393-8418
Practice Address - Fax:270-393-8440
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38494204D00000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64083314Medicaid
KY000000329382OtherANTHEM
KY1950401Medicare PIN
KY64083314Medicaid