Provider Demographics
NPI:1407191133
Name:BAKARE, MEENA AJIT (MD)
Entity type:Individual
Prefix:DR
First Name:MEENA
Middle Name:AJIT
Last Name:BAKARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-3124
Mailing Address - Country:US
Mailing Address - Phone:337-468-2515
Mailing Address - Fax:
Practice Address - Street 1:1008 6TH ST
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-3124
Practice Address - Country:US
Practice Address - Phone:337-468-2515
Practice Address - Fax:337-468-2517
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.06105R208000000X
LAMD.6105R2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1331384Medicaid