Individual
BIJAN BASTANINEJAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2620 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3396
(573) 785-7721
(573) 727-2465
Mailing address
PO BOX 1308, POPLAR BLUFF, MO 63902-1308
(573) 843-8380
(573) 843-8381
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
237324
NY
208000000X
Pediatrics Physician
Primary
2009039681
MO
208000000X
Pediatrics Physician
35.088489
OH
208M00000X
Hospitalist Physician
35.088489
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000488786
ANTHEM
OH
01
—
000000520832
ANTHEM
OH
05
—
02695054
—
NY
01
—
05227
PARAMOUNT
OH
01
—
237324
BLUECROSS BLUESHIELD
NY
05
—
2678446
—
OH
01
—
40113
HPM
MI
05
—
4920459
—
MI
05
—
5202199
—
MI
01
—
7210867
AETNA
OH
Enumeration date
12/21/2005
Last updated
11/07/2023
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