MEDICARE: DR. QASIM MUSTAFA BAJWA MD

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	2085R0202X	Diagnostic Radiology Physician	102285	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00188577	OTHER	MO	MEDICARE RR W/PALMARIS
2	P00236359	OTHER	MO	MEDICARE RR W/QASIM M. BA

Other Identifiers

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

General Provider Information

NPI Number	:	1578548517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. QASIM MUSTAFA BAJWA MD

Provider Business Mailing Address
First Line	:	104 COUNTRY CREEK CT
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-3812
Country	:	US
Telephone Number	:	314-550-3494
Fax Number	:	636-230-5732

Provider Business Practice Location Address
First Line	:	1014 N MAIN ST
Second Line	:
City	:	SIKESTON
State	:	MO
Zip	:	63801-5044
Country	:	US
Telephone Number	:	573-472-9993
Fax Number	:	573-472-9997

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	12/29/2020

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