Provider Demographics
NPI:1033297031
Name:OBEIDOU, BASHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:OBEIDOU
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 1:8950 N KENDALL DR
Mailing Address - Street 2:SUITE 601
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2139
Mailing Address - Country:US
Mailing Address - Phone:305-279-4500
Mailing Address - Fax:
Practice Address - Street 1:8950 N KENDALL DR
Practice Address - Street 2:SUITE 601
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2144
Practice Address - Country:US
Practice Address - Phone:305-279-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63546207RI0011X
FLME124405207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1898759Medicaid
SC240484Medicaid
SCH95744Medicare UPIN
LA5DN95Medicare PIN
SC240484Medicaid