Basic Information
| Provider Information | |||||||||
| NPI: | 1467510677 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAQHAR MOHIDEEN MD, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1485 | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463841485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197591441 | ||||||||
| FaxNumber: | 2197386714 | ||||||||
| Practice Location | |||||||||
| Address1: | 3630 WILLOWCREEK RD | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463685075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197591441 | ||||||||
| FaxNumber: | 2197386714 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/04/2006 | ||||||||
| LastUpdateDate: | 06/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | MOHIDEEN | ||||||||
| AuthorizedOfficialFirstName: | BAQHAR | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN-OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2197591441 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 01055496 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 200356250 | 05 | IN | MEDICAID |