Provider Demographics
NPI:1750485363
Name:BAHADURSINGH, ANIL M (MD)
Entity type:Individual
Prefix:
First Name:ANIL
Middle Name:M
Last Name:BAHADURSINGH
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 1:1079 S WINDY RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-2121
Mailing Address - Country:US
Mailing Address - Phone:314-378-2370
Mailing Address - Fax:
Practice Address - Street 1:411 N LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3028
Practice Address - Country:US
Practice Address - Phone:714-279-5431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011238208C00000X
CAC52471208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
7193400OtherAETNA
MO20053023OtherRAILROAD MEDICARE
157994OtherBLUE CROSS BLUE SHIELD
MO205855901Medicaid
77535OtherHEALTH ALLIANCE
482649OtherHEALTHLINK
H62939Medicare UPIN
MO205855901Medicaid