=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699814863
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM J BAJOREK DO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2007
-----------------------------------------------------
Last Update Date | 10/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 E KEMPER RD SUITE 100
-----------------------------------------------------
City | SPRINGDALE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-3903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-671-7246
-----------------------------------------------------
Fax | 513-671-4786
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1471 FRANK WILLIS MEML RD
-----------------------------------------------------
City | NEW RICHMOND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45157-8657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 543-553-3288
-----------------------------------------------------
Fax | 513-553-2928
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WILLIAM JOSEPH BAJOREK
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 513-553-3288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 34-00-3487
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------