Provider Demographics
NPI:1427052299
Name:KAYALI, BASHAR F (MD)
Entity type:Individual
Prefix:
First Name:BASHAR
Middle Name:F
Last Name:KAYALI
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:PO BOX 228
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:OH
Mailing Address - Zip Code:43138-0228
Mailing Address - Country:US
Mailing Address - Phone:740-385-3069
Mailing Address - Fax:740-385-0865
Practice Address - Street 1:31480 CHIEFTAIN DR
Practice Address - Street 2:SUITE D
Practice Address - City:LOGAN
Practice Address - State:OH
Practice Address - Zip Code:43138-9000
Practice Address - Country:US
Practice Address - Phone:740-385-3069
Practice Address - Fax:740-385-0865
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058062208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0728225Medicaid
OH0728225Medicaid