Provider Demographics
NPI:1497745061
Name:BASMAJI, ERIC NILE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:NILE
Last Name:BASMAJI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:416 CONNABLE AVENUE
Mailing Address - Street 2:NORTHERN MICHIGAN REGIONAL HOSPITAL
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770
Mailing Address - Country:US
Mailing Address - Phone:231-487-4000
Mailing Address - Fax:248-476-1780
Practice Address - Street 1:416 CONNABLE AVENUE
Practice Address - Street 2:NORTHERN MICHIGAN REGIONAL HOSPITAL
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770
Practice Address - Country:US
Practice Address - Phone:231-487-4000
Practice Address - Fax:248-476-1780
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIEB072525207R00000X
MI4301072525208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4310128Medicaid
MI4310128Medicaid
MI0P03690Medicare ID - Type Unspecified