Provider Demographics
NPI:1295839520
Name:QASIM M. BAJWA, LLC
Entity Type:Organization
Organization Name:QASIM M. BAJWA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QASIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAJWA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-550-3494
Mailing Address - Street 1:104 COUNTRY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3812
Mailing Address - Country:US
Mailing Address - Phone:314-550-3494
Mailing Address - Fax:636-230-5732
Practice Address - Street 1:100 W US HIGHWAY 60
Practice Address - Street 2:DEPT. OF RADIOLOGY
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:MO
Practice Address - Zip Code:65548-8542
Practice Address - Country:US
Practice Address - Phone:417-934-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MONA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO197819OtherBCBS
DD5708OtherMEDICARE RAILROAD