Provider Demographics
NPI:1750932331
Name:ISSE, ZAKARIA
Entity type:Individual
Prefix:
First Name:ZAKARIA
Middle Name:
Last Name:ISSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 BUSCH BLVD STE 165
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2553
Mailing Address - Country:US
Mailing Address - Phone:614-209-1320
Mailing Address - Fax:
Practice Address - Street 1:6161 BUSCH BLVD STE 165
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2553
Practice Address - Country:US
Practice Address - Phone:614-209-1320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver