Provider Demographics
NPI:1700808011
Name:KATIRJI, BASHAR (MD)
Entity Type:Individual
Prefix:
First Name:BASHAR
Middle Name:
Last Name:KATIRJI
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0492522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000510672OtherANTHEM
OH741868OtherBUCKEYE MEDICAID
OH000000221091OtherUNISON
OH0666220OtherBCMH
OH363685OtherWELLCARE MEDICAID
OH0641968OtherAETNA
OHP00369573OtherMEDICARE RAILROAD
OH0666220Medicaid
130023887OtherMCR RR
130023887OtherMCR RR
130023887OtherMCR RR
OH0666220OtherBCMH
OHKA4060629Medicare PIN