Healthcare Provider Details

I. General information

NPI: 1427052299
Provider Name (Legal Business Name): BASHAR F KAYALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31480 CHIEFTAIN DR SUITE D
LOGAN OH
43138-9000
US

IV. Provider business mailing address

PO BOX 228
LOGAN OH
43138-0228
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-3069
  • Fax: 740-385-0865
Mailing address:
  • Phone: 740-385-3069
  • Fax: 740-385-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35058062
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: