Provider Demographics
NPI:1093712952
Name:MOURAD, MOHAMMAD BASHAR (MD)
Entity Type:Individual
Prefix:MR
First Name:MOHAMMAD
Middle Name:BASHAR
Last Name:MOURAD
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:PO BOX 5705
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5705
Mailing Address - Country:US
Mailing Address - Phone:812-492-1960
Mailing Address - Fax:270-689-1990
Practice Address - Street 1:9355 WARRICK TRL
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-0015
Practice Address - Country:US
Practice Address - Phone:270-689-1919
Practice Address - Fax:270-689-1990
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32887207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000210578OtherANTHEM PIN
INCJ7612OtherRAILROAD MEDICARE
IN200367690Medicaid
IN000000210578OtherANTHEM PIN
KY64328875Medicaid
KYCJ7612OtherRAILROAD MEDIARE
IN249200AMedicare PIN
KY000000210578OtherANTHEM PIN
IN000000210578OtherANTHEM PIN
KYF74346Medicare UPIN