Provider Demographics
NPI:1548230345
Name:JISHI, BASIM M (MD)
Entity Type:Individual
Prefix:DR
First Name:BASIM
Middle Name:M
Last Name:JISHI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5308 N GALLOWAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-1122
Mailing Address - Country:US
Mailing Address - Phone:972-226-0505
Mailing Address - Fax:972-289-9640
Practice Address - Street 1:5308 N GALLOWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1122
Practice Address - Country:US
Practice Address - Phone:972-226-0505
Practice Address - Fax:972-289-9640
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-04-01
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Provider Licenses
StateLicense IDTaxonomies
TXE5394207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
B23771Medicare UPIN