Provider Demographics
NPI:1073565214
Name:BASHA, BASSEM JAMIL (MD)
Entity Type:Individual
Prefix:DR
First Name:BASSEM
Middle Name:JAMIL
Last Name:BASHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15144 LEVAN RD
Mailing Address - Street 2:SUITE 44
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5027
Mailing Address - Country:US
Mailing Address - Phone:734-779-2136
Mailing Address - Fax:734-779-2155
Practice Address - Street 1:15144 LEVAN RD
Practice Address - Street 2:SUITE 44
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-5027
Practice Address - Country:US
Practice Address - Phone:734-779-2136
Practice Address - Fax:734-779-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2021-06-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052316207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4517166Medicaid
MI4517166Medicaid
MI0N95620Medicare ID - Type Unspecified