Provider Demographics
NPI:1720284367
Name:BAKAR, AYLA (MD)
Entity Type:Individual
Prefix:
First Name:AYLA
Middle Name:
Last Name:BAKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W MEDICAL CENTER DR STE B202
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8417
Mailing Address - Country:US
Mailing Address - Phone:815-338-6600
Mailing Address - Fax:815-759-6208
Practice Address - Street 1:4309 W MEDICAL CENTER DR STE B202
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050
Practice Address - Country:US
Practice Address - Phone:815-338-6600
Practice Address - Fax:815-759-6208
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81428207RE0101X
IN01065959A207RE0101X
IL036142774207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036142774OtherSTATE LICENSE
IN200941140Medicaid
INP01270949OtherRR MEDICARE
ININ1663013Medicare PIN
INP01270949OtherRR MEDICARE