Individual
DR. IMAN BASTAWROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4441 FAR HILLS AVE, KETTERING, OH 45429-2405
(937) 298-7351
(937) 298-9458
Mailing address
4441 FAR HILLS AVE, KETTERING, OH 45429-2405
(937) 298-7351
(937) 298-9458
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.132323
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000494990
ANTHEM
KY
05
—
2992141
—
OH
05
—
64128341
—
KY
Enumeration date
05/18/2006
Last updated
11/19/2020
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