Provider Demographics
NPI:1255482394
Name:MITTAL, BAHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:MITTAL
Suffix:
Gender:F
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-912-7211
Mailing Address - Fax:859-655-6674
Practice Address - Street 1:85 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1793
Practice Address - Country:US
Practice Address - Phone:859-912-7211
Practice Address - Fax:859-655-6674
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000363598OtherBLUESHIELD NUMBER
KYP01459741OtherRR MEDICARE
KY64114523Medicaid
OH0118432Medicaid
KYP01459741OtherRR MEDICARE
OH0118432Medicaid