Provider Demographics
NPI:1124327507
Name:KATRIB, ZIAD A (MD)
Entity type:Individual
Prefix:
First Name:ZIAD
Middle Name:A
Last Name:KATRIB
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201
Mailing Address - Country:US
Mailing Address - Phone:502-588-0329
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:401 E CHESTNUT ST UNIT 170
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5701
Practice Address - Country:US
Practice Address - Phone:502-583-3687
Practice Address - Fax:502-588-7840
Is Sole Proprietor?:No
Enumeration Date:2011-03-24
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28135207Y00000X
KY50689207Y00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK243520OtherMEDICARE
KY7100214580Medicaid