Basic Information
| Provider Information | |||||||||
| NPI: | 1053345231 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HADI | ||||||||
| FirstName: | BASSAM | ||||||||
| MiddleName: | AR | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10012 KENNERLY RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631282197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145435999 | ||||||||
| FaxNumber: | 3145435994 | ||||||||
| Practice Location | |||||||||
| Address1: | 10012 KENNERLY RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631282197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145435999 | ||||||||
| FaxNumber: | 3145435994 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 08/11/2014 | ||||||||
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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 | 207T00000X | 27832 | OK | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 31394 | KY | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 2003009742 | MO | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 6401627200 | 05 | KY | MEDICAID | P00732227 | 01 | KY | MEDICARE PTAN | OTHER | 64016272 | 05 | KY | MEDICAID | 000000525779 | 01 | KY | BLUECROSS | OTHER | 200316690A | 05 | OK | MEDICAID |