Provider Demographics
NPI:1326059957
Name:BASTANI, BAHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BAHAR
Middle Name:
Last Name:BASTANI
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:SLUCARE ACADEMIC PAVILION
Mailing Address - Street 2:1008 S. SPRING
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110
Mailing Address - Country:US
Mailing Address - Phone:314-973-4994
Mailing Address - Fax:
Practice Address - Street 1:AMBULATORY CARE CENTER
Practice Address - Street 2:1225 S. GRAND BLVD
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-1016
Practice Address - Country:US
Practice Address - Phone:314-577-8765
Practice Address - Fax:314-771-0784
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7H14207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology