Provider Demographics
NPI:1124154331
Name:QUALCOMP PREFERRED MEDICAL CONSULTANTS.PC
Entity type:Organization
Organization Name:QUALCOMP PREFERRED MEDICAL CONSULTANTS.PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKDASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-208-0823
Mailing Address - Street 1:10341 AURORA CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-5510
Mailing Address - Country:US
Mailing Address - Phone:765-208-0823
Mailing Address - Fax:765-298-4980
Practice Address - Street 1:2401 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3428
Practice Address - Country:US
Practice Address - Phone:765-747-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047723A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN215110AMedicare ID - Type Unspecified
ING61032Medicare UPIN