Provider Demographics
NPI:1063543700
Name:AMIRLAK, BARDIA (MD)
Entity type:Individual
Prefix:
First Name:BARDIA
Middle Name:
Last Name:AMIRLAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVERPOINTE PLZ APT 702
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3210
Mailing Address - Country:US
Mailing Address - Phone:402-968-3528
Mailing Address - Fax:
Practice Address - Street 1:1 RIVERPOINTE PLZ APT 702
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3210
Practice Address - Country:US
Practice Address - Phone:402-968-3528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY402032086S0105X
IN11013193A2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand