Provider Demographics
NPI:1699707794
Name:ZIEBA, PAWEL A (MD)
Entity type:Individual
Prefix:
First Name:PAWEL
Middle Name:A
Last Name:ZIEBA
Suffix:
Gender:
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:LAREDO MEDICAL CENTER
Mailing Address - Street 2:1700 EAST SAUNDERS ST
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5474
Mailing Address - Country:US
Mailing Address - Phone:956-796-4488
Mailing Address - Fax:956-796-4453
Practice Address - Street 1:LAREDO MEDICAL CENTER
Practice Address - Street 2:1700 EAST SAUNDERS ST
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5474
Practice Address - Country:US
Practice Address - Phone:956-796-4488
Practice Address - Fax:956-796-4453
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01072478A2080N0001X
ND154042080N0001X
KY456542080N0001X
IDM-87012080N0001X
TXV46312080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000780853OtherANTHEM - KCNS
KY64938848Medicaid
IN20034700Medicaid
LA50042407OtherPASSPORT - KCNS
KY138991OtherSIHO - KCNS
LA50042407OtherPASSPORT - KCNS