Provider Demographics
NPI:1780742353
Name:MOHIDEEN, BAQHAR (MD)
Entity type:Individual
Prefix:
First Name:BAQHAR
Middle Name:
Last Name:MOHIDEEN
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:PO BOX 1485
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46384-1485
Mailing Address - Country:US
Mailing Address - Phone:219-756-1441
Mailing Address - Fax:219-738-6714
Practice Address - Street 1:3630 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-5075
Practice Address - Country:US
Practice Address - Phone:219-759-1441
Practice Address - Fax:219-738-6714
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055496207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200356250Medicaid
IN224010AMedicare PIN
IN200356250Medicaid