Basic Information
| Provider Information | |||||||||
| NPI: | 1063488765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIAB | ||||||||
| FirstName: | ISAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20525 CENTER RIDGE ROAD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | ROCKY RIVER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408955056 | ||||||||
| FaxNumber: | 4403332935 | ||||||||
| Practice Location | |||||||||
| Address1: | 18660 BAGLEY ROAD | ||||||||
| Address2: | #102B | ||||||||
| City: | MIDDLEBURG HTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408919395 | ||||||||
| FaxNumber: | 4408911765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 35059458D | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 341783789049 | 01 | CARESOURCE | OTHER | 350849 | 01 | WELLCARE MEDICAID | OTHER | 3200064 | 01 | UNITED HEALTHCARE | OTHER | CA4511 | 01 | RR MEDICARE GROUP | OTHER | 0786707 | 05 | OH | MEDICAID | 4247166 | 01 | OH | AETNA | OTHER | 0119204 | 01 | GROUP MEDICAID | OTHER | 3610861 | 01 | OH | ASC GROUP MEDICARE | OTHER | F59458 | 01 | SUMMACARE APEX | OTHER | 000000031889 | 01 | ANTHEM | OTHER | 1780634279 | 01 | GROUP NPI | OTHER | D368301 | 01 | OH | DIAGNOSTIC GROUP MEDICARE | OTHER | 102940 | 01 | KAISER | OTHER | 9273172 | 01 | OH | GROUP MEDICARE | OTHER |