Provider Demographics
NPI:1407840234
Name:DAHMAN, BASSEM (MD)
Entity Type:Individual
Prefix:
First Name:BASSEM
Middle Name:
Last Name:DAHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22151 MOROSS RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2167
Mailing Address - Country:US
Mailing Address - Phone:313-343-3978
Mailing Address - Fax:313-417-2730
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:270
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2169
Practice Address - Country:US
Practice Address - Phone:313-343-3481
Practice Address - Fax:313-343-7937
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301032984208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4613556Medicaid
M71670Medicare ID - Type Unspecified
MI4613556Medicaid