Healthcare Provider Details

I. General information

NPI: 1568458016
Provider Name (Legal Business Name): RAJBIR SINGH BAJWA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W HIGH ST SUITE 102
LIMA OH
45801-3971
US

IV. Provider business mailing address

830 W HIGH ST SUITE 102
LIMA OH
45801-3971
US

V. Phone/Fax

Practice location:
  • Phone: 419-222-4045
  • Fax: 419-228-5665
Mailing address:
  • Phone: 419-222-4045
  • Fax: 419-228-5665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3569621
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00000012834
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM BC/BS
# 2
Identifier0213638
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 3
Identifier000000523222
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM
# 4
Identifier5021422
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerAETNA
# 5
Identifier000000126833
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerANTHEM BENEFITS SERVICES
# 6
Identifier1843994
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerUNITED HEALTHCARE
# 7
Identifier341086500005
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerMEDICAL MUTUAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: