Provider Demographics
NPI:1942281415
Name:BAKLEH, MOHANAD (MD)
Entity Type:Individual
Prefix:
First Name:MOHANAD
Middle Name:
Last Name:BAKLEH
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 1:716 BEDELL LN
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094-4260
Mailing Address - Country:US
Mailing Address - Phone:214-501-2592
Mailing Address - Fax:
Practice Address - Street 1:716 BEDELL LN
Practice Address - Street 2:
Practice Address - City:MURPHY
Practice Address - State:TX
Practice Address - Zip Code:75094-4260
Practice Address - Country:US
Practice Address - Phone:214-501-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7840207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200266430CMedicaid
KS200266430AMedicaid
KS200266430AMedicaid
KS200266430CMedicaid
TXH61367Medicare UPIN
KSKA1000002Medicare PIN