Provider Demographics
NPI:1902993256
Name:M BADR MD INC
Entity Type:Organization
Organization Name:M BADR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:BADR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-768-6800
Mailing Address - Street 1:703 W GRAHAM AVE
Mailing Address - Street 2:101
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-3514
Mailing Address - Country:US
Mailing Address - Phone:760-768-6800
Mailing Address - Fax:760-768-6886
Practice Address - Street 1:703 W GRAHAM AVE
Practice Address - Street 2:101
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-3514
Practice Address - Country:US
Practice Address - Phone:760-768-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56397207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19174Medicare ID - Type UnspecifiedGROUP PROVIDER