Provider Demographics
NPI:1598716631
Name:BASH, JAMES D (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:BASH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2331 PROGRESS ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9384
Mailing Address - Country:US
Mailing Address - Phone:989-345-1184
Mailing Address - Fax:989-345-6944
Practice Address - Street 1:2331 PROGRESS ST
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9384
Practice Address - Country:US
Practice Address - Phone:989-345-1184
Practice Address - Fax:989-345-6944
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00258717OtherRAILROAD MEDICARE
MI4737339Medicaid
MI4737366Medicaid
MI700G210140OtherBCBS GROUP
MI08OG21014OtherBCBS
MI4737320Medicaid
MIB47457Medicare UPIN
MIOP19260 002Medicare PIN