Provider Demographics
NPI:1326040510
Name:ALMASRI, BASEM (MD)
Entity Type:Individual
Prefix:DR
First Name:BASEM
Middle Name:
Last Name:ALMASRI
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 1:25710 KELLY RD
Mailing Address - Street 2:STE 3
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4959
Mailing Address - Country:US
Mailing Address - Phone:586-772-2600
Mailing Address - Fax:586-772-5289
Practice Address - Street 1:25710 KELLY RD
Practice Address - Street 2:STE 3
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4959
Practice Address - Country:US
Practice Address - Phone:586-772-2600
Practice Address - Fax:586-772-5289
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075951207Q00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1326040510OtherNPI #
MI70-0-F32947-0OtherBCBS CPIN #
MIBA075951OtherBCBSM
MI4846324-10Medicaid
MIP28070024Medicare PIN
MIBA075951OtherBCBSM