Basic Information
| Provider Information | |||||||||
| NPI: | 1497837561 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOKARI | ||||||||
| FirstName: | BABAK | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 601067 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282601067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048011000 | ||||||||
| FaxNumber: | 7048962861 | ||||||||
| Practice Location | |||||||||
| Address1: | 12905 ROSEDALE HILL AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280783341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048011000 | ||||||||
| FaxNumber: | 7048962861 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 06/05/2013 | ||||||||
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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 | 207Q00000X | 2001-01105 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 20A8732 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 891372F | 05 | NC | MEDICAID |