Provider Demographics
NPI:1619246428
Name:BASMIT MEDICAL CENTER PC.
Entity Type:Organization
Organization Name:BASMIT MEDICAL CENTER PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BNAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAZOKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-883-6787
Mailing Address - Street 1:34764 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-5279
Mailing Address - Country:US
Mailing Address - Phone:586-883-6787
Mailing Address - Fax:586-883-6103
Practice Address - Street 1:34764 DEQUINDRE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5279
Practice Address - Country:US
Practice Address - Phone:586-883-6787
Practice Address - Fax:586-883-6103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301082048261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1942317789OtherNPI