Provider Demographics
NPI:1295802403
Name:BAINS, HARCHARAN (MD)
Entity type:Individual
Prefix:
First Name:HARCHARAN
Middle Name:
Last Name:BAINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1500 N OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:MO
Mailing Address - Zip Code:65613-3011
Mailing Address - Country:US
Mailing Address - Phone:417-328-6501
Mailing Address - Fax:417-328-6338
Practice Address - Street 1:1120 S SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:MO
Practice Address - Zip Code:65613-2512
Practice Address - Country:US
Practice Address - Phone:417-326-7814
Practice Address - Fax:417-326-4059
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20060340052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO138880008Medicare Oscar/Certification
MOI73029Medicare UPIN
MOP00687261Medicare Oscar/Certification