Provider Demographics
NPI:1144421355
Name:BAHADUR, FAISAL A (MD)
Entity Type:Individual
Prefix:DR
First Name:FAISAL
Middle Name:A
Last Name:BAHADUR
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 1:2487 S GILBERT RD
Mailing Address - Street 2:STE 106-486
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-8899
Mailing Address - Country:US
Mailing Address - Phone:480-699-5536
Mailing Address - Fax:480-699-9283
Practice Address - Street 1:3011 S LINDSAY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4332
Practice Address - Country:US
Practice Address - Phone:480-699-5536
Practice Address - Fax:480-699-9283
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2014-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46291207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ698571Medicaid
AZ18168OtherMICA