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NPI Code Detail

MEDICARE: QASIM M. BAJWA, LLC

MEDICARE: QASIM M. BAJWA, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology PhysicianNAMO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DD5708OTHERMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1197819OTHERMOBCBS

General Provider Information

NPI Number : 1295839520
Entity Type Code : Organization
Provider Name (Legal Business Name) : QASIM M. BAJWA, LLC
Provider Business Mailing Address
First Line : 104 COUNTRY CREEK CT
Second Line :
City : BALLWIN
State : MO
Zip : 63011-3812
Country : US
Telephone Number : 314-550-3494
Fax Number : 636-230-5732
Provider Business Practice Location Address
First Line : 100 W US HIGHWAY 60
Second Line : DEPT. OF RADIOLOGY
City : MOUNTAIN VIEW
State : MO
Zip : 65548-8542
Country : US
Telephone Number : 417-934-7000
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. QASIM M BAJWA
Credential : MD
Telephone Number : 314-550-3494
Provider Enumeration Date : 09/08/2006
Last Update Date : 11/21/2007

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