Provider Demographics
NPI:1740267533
Name:VIRK, ZIAULLAH (MD)
Entity type:Individual
Prefix:DR
First Name:ZIAULLAH
Middle Name:
Last Name:VIRK
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:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-0959
Mailing Address - Country:US
Mailing Address - Phone:606-435-2961
Mailing Address - Fax:
Practice Address - Street 1:1908 N MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2503
Practice Address - Country:US
Practice Address - Phone:606-439-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD13689R207RR0500X
LA13689R207RR0500X
TXN6757207RR0500X
KY48955207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1035891Medicaid
MS03005261Medicaid
NC89129K7Medicaid
KY7100420880Medicaid
H53594Medicare UPIN