MEDICARE: BASHAR F KAYALI 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	208000000X	Pediatrics Physician	35058062	OH

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	:	1427052299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BASHAR F KAYALI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 228
Second Line	:
City	:	LOGAN
State	:	OH
Zip	:	43138-0228
Country	:	US
Telephone Number	:	740-385-3069
Fax Number	:	740-385-0865

Provider Business Practice Location Address
First Line	:	31480 CHIEFTAIN DR
Second Line	:	SUITE D
City	:	LOGAN
State	:	OH
Zip	:	43138-9000
Country	:	US
Telephone Number	:	740-385-3069
Fax Number	:	740-385-0865

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/10/2014

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