Basic Information
| Provider Information | |||||||||
| NPI: | 1124154331 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | QUALCOMP PREFERRED MEDICAL CONSULTANTS.PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10341 AURORA CT | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460385510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652080823 | ||||||||
| FaxNumber: | 7652984980 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 W UNIVERSITY AVE | ||||||||
| Address2: | |||||||||
| City: | MUNCIE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 473033428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7657473111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAKDASH | ||||||||
| AuthorizedOfficialFirstName: | WAIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7652080823 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 01047723A | IN | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.