Provider Demographics
NPI:1073560355
Name:BASHAR SUCCAR MD PC
Entity Type:Organization
Organization Name:BASHAR SUCCAR MD PC
Other - Org Name:MICHIGAN EAR NOSE AND THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCCAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-334-9490
Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5045
Mailing Address - Country:US
Mailing Address - Phone:248-334-9490
Mailing Address - Fax:248-636-1170
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5045
Practice Address - Country:US
Practice Address - Phone:248-334-9490
Practice Address - Fax:248-636-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4470874Medicaid
MIA77137Medicare UPIN
MI4470874Medicaid
MIB45382Medicare UPIN
MIH62716Medicare UPIN