Provider Demographics
NPI:1982718979
Name:KARIM BAKHTIAR MD SC
Entity Type:Organization
Organization Name:KARIM BAKHTIAR MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKHTIAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-384-2688
Mailing Address - Street 1:4555 WEST SCHROEDER DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223
Mailing Address - Country:US
Mailing Address - Phone:414-365-3210
Mailing Address - Fax:414-365-3225
Practice Address - Street 1:1400 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4624
Practice Address - Country:US
Practice Address - Phone:414-384-2688
Practice Address - Fax:414-384-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21250300Medicaid
WI000002787Medicare PIN