Provider Demographics
NPI:1164732038
Name:MIAH, BAHAR (MD)
Entity Type:Individual
Prefix:
First Name:BAHAR
Middle Name:
Last Name:MIAH
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 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:901 N LAKE DESTINY RD
Practice Address - Street 2:SUITE 400
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4844
Practice Address - Country:US
Practice Address - Phone:407-200-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 108183207Q00000X
FLME108183207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME 108183OtherMEDICAL LICENSE