Provider Demographics
NPI:1619930575
Name:BASCH, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:BASCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5555 GLENWOOD HILLS PKWY SE STE 2
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49512-2091
Mailing Address - Country:US
Mailing Address - Phone:616-940-2662
Mailing Address - Fax:616-940-1965
Practice Address - Street 1:2147 HEALTH DR SW STE 100
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9675
Practice Address - Country:US
Practice Address - Phone:616-281-1600
Practice Address - Fax:616-281-2247
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301063063207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4606560-10Medicaid
5070255OtherCIGNA
7000034231OtherPRIORITY HEALTH
MI4514558-10Medicaid
7624881OtherAETNA
16642OtherHEALTH PLAN OF MICHIGAN
P00061534OtherRAIL ROAD MEDICARE
MI550415528OtherBLUE CROSS BLUE SHIELD
MI4606551-10Medicaid
MI4514558-10Medicaid
MID16000013Medicare PIN