Healthcare Provider Details

I. General information

NPI: 1538669296
Provider Name (Legal Business Name): NIZAR JACQUES J BAHLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2018
Last Update Date: 02/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WINSHIP CANCER INSTITUTE 1365 CLIFTON RD BUILDING C
ATLANTA GA
30322-0001
US

IV. Provider business mailing address

717 21 ST NW
CALGARY AB
241
CA

V. Phone/Fax

Practice location:
  • Phone: 403-608-8861
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number78362
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: