Provider Demographics
NPI:1043507379
Name:SKA AT HOME VISITING DOCTOR PC
Entity Type:Organization
Organization Name:SKA AT HOME VISITING DOCTOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NASIR
Authorized Official - Middle Name:AZ
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-990-2771
Mailing Address - Street 1:1302 N EATON ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1302 N EATON ST STE A
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1041
Practice Address - Country:US
Practice Address - Phone:517-990-2771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPENDINGMedicaid
MIPENDEDOtherBLUE CROSS OF MI
MIPENDINGMedicaid