Provider Demographics
NPI:1437192614
Name:ZIAD MICHEL MARJIEH M D P A
Entity type:Organization
Organization Name:ZIAD MICHEL MARJIEH M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZIAD
Authorized Official - Middle Name:MICHEL
Authorized Official - Last Name:MARJIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-461-0915
Mailing Address - Street 1:2100 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4831
Mailing Address - Country:US
Mailing Address - Phone:772-461-0915
Mailing Address - Fax:772-461-4114
Practice Address - Street 1:2100 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4831
Practice Address - Country:US
Practice Address - Phone:772-461-0915
Practice Address - Fax:772-461-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041814500Medicaid
FL10D0967529OtherCLIA
FL010012463OtherRAIL ROAD MEDICARE
FL=========OtherFEIN NUMBER
FL041814500Medicaid
FLDZ620AMedicare PIN