Individual
ISAM DIAB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18660 BAGLEY ROAD, #102B, MIDDLEBURG HTS, OH 44130
(440) 891-9395
(440) 891-1765
Mailing address
20525 CENTER RIDGE ROAD, SUITE 220, ROCKY RIVER, OH 44116
(440) 895-5056
(440) 333-2935
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
35059458D
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000031889
ANTHEM
—
01
—
0119204
GROUP MEDICAID
—
05
—
0786707
—
OH
01
—
102940
KAISER
—
01
—
1780634279
GROUP NPI
—
01
—
3200064
UNITED HEALTHCARE
—
01
—
341783789049
CARESOURCE
—
01
—
350849
WELLCARE MEDICAID
—
01
—
3610861
ASC GROUP MEDICARE
OH
01
—
4247166
AETNA
OH
01
—
9273172
GROUP MEDICARE
OH
01
—
CA4511
RR MEDICARE GROUP
—
01
—
D368301
DIAGNOSTIC GROUP MEDICARE
OH
01
—
F59458
SUMMACARE APEX
—
Enumeration date
02/23/2006
Last updated
05/27/2008
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