MEDICARE: DR. SIAR AHMAD BASHARMAL 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	207R00000X	Internal Medicine Physician	A91350	CA

General Provider Information

NPI Number	:	1639168099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIAR AHMAD BASHARMAL M.D.

Provider Business Mailing Address
First Line	:	1006 BUTTERNUT CT
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90746-7488
Country	:	US
Telephone Number	:	310-851-4705
Fax Number	:

Provider Business Practice Location Address
First Line	:	1251 W REDONDO BEACH BLVD
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-3456
Country	:	US
Telephone Number	:	310-851-4705
Fax Number	:

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	06/01/2009

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