Provider Demographics
NPI:1235945700
Name:KODIAK PHYSIATRY CONSULTING
Entity type:Organization
Organization Name:KODIAK PHYSIATRY CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILAAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SAIF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:240-291-0197
Mailing Address - Street 1:5 PUBLIC SQ ST 301
Mailing Address - Street 2:#604
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740
Mailing Address - Country:US
Mailing Address - Phone:240-291-0197
Mailing Address - Fax:
Practice Address - Street 1:141 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONSBORO
Practice Address - State:MD
Practice Address - Zip Code:21713-1203
Practice Address - Country:US
Practice Address - Phone:301-432-5457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty