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General NPI Number Information
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NPI Number | 1578548517
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Entity Type | Individual
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Provider Name | QASIM MUSTAFA BAJWA MD
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Gender | Male
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 12/29/2020
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Provider Practice Location Address
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Address Line | 1014 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5044
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Country | US
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Telephone | 573-472-9993
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Fax | 573-472-9997
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Provider Business Mailing Address
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Address Line | 104 COUNTRY CREEK CT
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City | BALLWIN
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State | MO
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Zip | 63011-3812
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Country | US
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Telephone | 314-550-3494
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Fax | 636-230-5732
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 102285
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License Number State | MO
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