Provider Demographics
NPI:1700880390
Name:SAIKALY, BASHAR S (MD)
Entity type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:S
Last Name:SAIKALY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3550 UNIVERSITY BLVD S
Mailing Address - Street 2:STE 302
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4225
Mailing Address - Country:US
Mailing Address - Phone:904-733-4444
Mailing Address - Fax:904-733-5377
Practice Address - Street 1:300 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 1006
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3707
Practice Address - Country:US
Practice Address - Phone:904-794-7050
Practice Address - Fax:904-794-7135
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-08-09
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Provider Licenses
StateLicense IDTaxonomies
FLME 78252207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL060055960OtherRAILROAD MEDICARE
FL46619OtherBCBS
FL258342900Medicaid
FL46619OtherBCBS
FL258342900Medicaid
FL46619ZMedicare PIN
FL46619XMedicare PIN