Basic Information
| Provider Information | |||||||||
| NPI: | 1255482394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MITTAL | ||||||||
| FirstName: | BAHAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 635283 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452635283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599127211 | ||||||||
| FaxNumber: | 8596556674 | ||||||||
| Practice Location | |||||||||
| Address1: | 85 N GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | FORT THOMAS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410751793 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8599127211 | ||||||||
| FaxNumber: | 8596556674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 03/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 38913 | KY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000363598 | 01 | KY | BLUESHIELD NUMBER | OTHER | P01459741 | 01 | KY | RR MEDICARE | OTHER | 64114523 | 05 | KY | MEDICAID | 0118432 | 05 | OH | MEDICAID |