Provider Demographics
NPI:1346949526
Name:ATEYE, BASHIR AWIL
Entity Type:Individual
Prefix:
First Name:BASHIR
Middle Name:AWIL
Last Name:ATEYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WESTOVER CT
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-2201
Mailing Address - Country:US
Mailing Address - Phone:608-504-1891
Mailing Address - Fax:
Practice Address - Street 1:12 WESTOVER CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2201
Practice Address - Country:US
Practice Address - Phone:608-504-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0019236253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
882905822OtherIRS