Basic Information
| Provider Information | |||||||||
| NPI: | 1457369027 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISKANDARANI | ||||||||
| FirstName: | ZAHER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 906 E MOUNTAIN PKWY | ||||||||
| Address2: | |||||||||
| City: | SALYERSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 414658379 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063498100 | ||||||||
| FaxNumber: | 6063498150 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 W. LOTHBURY AVE. | ||||||||
| Address2: | |||||||||
| City: | MIDDLESBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 409654096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062485322 | ||||||||
| FaxNumber: | 6062489244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 08/27/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 32196 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64321961 | 05 | KY | MEDICAID |