Provider Demographics
NPI:1013021815
Name:BASHIR, KHALID (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALID
Middle Name:
Last Name:BASHIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7261 MERCY RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-2311
Mailing Address - Country:US
Mailing Address - Phone:402-398-6255
Mailing Address - Fax:
Practice Address - Street 1:7710 MERCY RD STE 426
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-2323
Practice Address - Country:US
Practice Address - Phone:402-343-8650
Practice Address - Fax:402-343-8545
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA36257207RN0300X
NE23165207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098684OtherMEDICARE PTAN
IA41453OtherMEDICARE PTAN
NE086156Medicare PIN
NE098684OtherMEDICARE PTAN
IA41947Medicare PIN
NEP00212510Medicare PIN
IA41453OtherMEDICARE PTAN