Bacchus, Harold Mustapha

Bacchus, Harold Mustapha is an individual health care provider with primary practice located at 1719 Cremer Ave , Fort Wayne IN 46818-1052. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Bacchus, Harold Mustapha can be contacted via phone (260) 490-9150.

Contact Information

Primary practice address
1719 Cremer Ave Fort Wayne IN 46818-1052
Phone: (260) 490-9150
Fax: (260) 490-9195
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01034833 Indiana

Profile Details

NPI number 1881654523
LBN Legal business name Bacchus, Harold Mustapha
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 25th, 2006
Last updated Dec 20th, 2009 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881654523 NPPES
Indiana Other 000000634416 ANTHEM
Indiana MEDICAID 200027190 ANTHEM

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