Provider Demographics
NPI:1154564656
Name:HAMMOUDEH, ZIYAD SHAWKAT (MD)
Entity type:Individual
Prefix:DR
First Name:ZIYAD
Middle Name:SHAWKAT
Last Name:HAMMOUDEH
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 1:1790 CORAL WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2771
Mailing Address - Country:US
Mailing Address - Phone:786-710-1600
Mailing Address - Fax:305-402-5880
Practice Address - Street 1:1790 CORAL WAY
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-2771
Practice Address - Country:US
Practice Address - Phone:786-710-1600
Practice Address - Fax:305-402-5880
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN106907208200000X
TXBP10041657208200000X
MN56901208200000X
MI4301092879208600000X
CAA115318208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
IAENROLLEDMedicaid
MN240000421Medicare PIN