Basic Information
| Provider Information | |||||||||
| NPI: | 1881122273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKDASH | ||||||||
| FirstName: | KENAZ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12631 E. 17TH AVE. | ||||||||
| Address2: | MS 8200 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037249245 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1633 N CAPITOL AVE STE 640 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462021281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179628881 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2017 | ||||||||
| LastUpdateDate: | 06/29/2018 | ||||||||
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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 | 390200000X | 11019282A | IN | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.