MEDICARE: BILAL HARAKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0202X	Pediatric Cardiology Physician	A44445	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215017223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BILAL HARAKE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1359
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92674-1359
Country	:	US
Telephone Number	:	949-492-3514
Fax Number	:	949-366-2390

Provider Business Practice Location Address
First Line	:	2425 BATH ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4324
Country	:	US
Telephone Number	:	805-569-3146
Fax Number	:	805-569-0786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/09/2007

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