Provider Demographics
NPI:1508189861
Name:ASAD A BAKIR MDSC
Entity Type:Organization
Organization Name:ASAD A BAKIR MDSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-937-1060
Mailing Address - Street 1:1112 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1453
Mailing Address - Country:US
Mailing Address - Phone:708-937-1060
Mailing Address - Fax:
Practice Address - Street 1:1112 LATHROP AVE
Practice Address - Street 2:
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1453
Practice Address - Country:US
Practice Address - Phone:708-937-1060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050525Medicaid
IL0021608880OtherBLUE CROSS
ILD14112Medicare UPIN
IL634191Medicare PIN