Provider Demographics
NPI:1548483761
Name:LUTFI, BASHAR (MD)
Entity type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:LUTFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9397 SATINLEAF PL
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-3960
Mailing Address - Country:US
Mailing Address - Phone:954-756-0615
Mailing Address - Fax:
Practice Address - Street 1:1725 N UNIVERSITY DR STE 425
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6000
Practice Address - Country:US
Practice Address - Phone:305-259-0092
Practice Address - Fax:786-545-7627
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 795522084N0400X
FLME79552208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35396YOtherMEDICARE PTAN
FL258930300Medicaid
FL258930300Medicaid