Provider Demographics
NPI:1912084518
Name:BAKALI, SALIM (MD)
Entity Type:Individual
Prefix:
First Name:SALIM
Middle Name:
Last Name:BAKALI
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 1:3035 HAMILTON MASON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5544
Mailing Address - Country:US
Mailing Address - Phone:513-863-3999
Mailing Address - Fax:513-863-2239
Practice Address - Street 1:3035 HAMILTON MASON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5544
Practice Address - Country:US
Practice Address - Phone:513-863-3999
Practice Address - Fax:513-863-2239
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-0448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0277089Medicaid
OH0818843Medicare PIN
OHF48809Medicare UPIN