Provider Demographics
NPI:1114953650
Name:MOHSEN, BASHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:MOHSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14261 COMMERCE WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1647
Mailing Address - Country:US
Mailing Address - Phone:305-698-4000
Mailing Address - Fax:305-698-4014
Practice Address - Street 1:14261 COMMERCE WAY STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1647
Practice Address - Country:US
Practice Address - Phone:305-698-4000
Practice Address - Fax:305-698-4014
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050307232084N0400X
TN472202084N0400X
FLME1106562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006690100Medicaid
MO958543230Medicare PIN
FL006690100Medicaid
FLGM389ZMedicare PIN
FLGM389ZMedicare PIN