Provider Demographics
NPI:1174920581
Name:ZAZA, ISAM (MD)
Entity type:Individual
Prefix:DR
First Name:ISAM
Middle Name:
Last Name:ZAZA
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 1:4735 E MARGINAL WAY S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98134-2388
Mailing Address - Country:US
Mailing Address - Phone:206-866-6400
Mailing Address - Fax:
Practice Address - Street 1:4735 E MARGINAL WAY S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-2388
Practice Address - Country:US
Practice Address - Phone:206-760-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061307208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice