Provider Demographics
NPI:1588735906
Name:MEENA A BAKARE MD APMC
Entity type:Organization
Organization Name:MEENA A BAKARE MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEENA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAKARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-468-2515
Mailing Address - Street 1:1008 6TH STREET
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:337-468-2517
Practice Address - Street 1:1008 6TH STREET
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD06105R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0185211570OtherBLUE CROSS
LA19D0461334OtherCLIA
LA1331384Medicaid
LA1331384Medicaid
B62500Medicare UPIN