Basic Information
| Provider Information | |||||||||
| NPI: | 1447469176 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAHARI | ||||||||
| FirstName: | ABBAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 SEAGATE STE 800 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436041558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5675851992 | ||||||||
| FaxNumber: | 4198247359 | ||||||||
| Practice Location | |||||||||
| Address1: | 1420 N MONROE ST | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481624211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342408480 | ||||||||
| FaxNumber: | 7343840469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 04/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 35134956 | OH | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | A121722 | CA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 4301087953 | MI | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | MI6270077 | 01 | MI | MEDICARE PIN | OTHER | 1447469176 | 05 | MI | MEDICAID |