1245355916 NPI number — DR. NAHEED TALAT BASHIR M.D.

Table of content: DR. NAHEED TALAT BASHIR M.D. (NPI 1245355916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245355916 NPI number — DR. NAHEED TALAT BASHIR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASHIR
Provider First Name:
NAHEED
Provider Middle Name:
TALAT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245355916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BRONZE POINTE
Provider Second Line Business Mailing Address:
SUITE 1-A
Provider Business Mailing Address City Name:
BELLEVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62226-8305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-233-7055
Provider Business Mailing Address Fax Number:
618-233-9055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BRONZE POINTE
Provider Second Line Business Practice Location Address:
STE 1A
Provider Business Practice Location Address City Name:
BELLEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62226-8305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-233-7055
Provider Business Practice Location Address Fax Number:
618-233-9055
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  261QP3300X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 869795 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 8232343 . This is a "BCBS OF IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036120409 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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