Provider Demographics
NPI:1164720884
Name:BAKARI, IDDI ALI
Entity Type:Individual
Prefix:
First Name:IDDI
Middle Name:ALI
Last Name:BAKARI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 W LIMESTONE ST
Mailing Address - Street 2:
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-1771
Mailing Address - Country:US
Mailing Address - Phone:937-327-8256
Mailing Address - Fax:
Practice Address - Street 1:590 W LIMESTONE ST
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1771
Practice Address - Country:US
Practice Address - Phone:937-327-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN278278163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse