Provider Demographics
NPI:1679747380
Name:DAVID BASCH DPM PC
Entity Type:Organization
Organization Name:DAVID BASCH DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BASCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-979-7502
Mailing Address - Street 1:39601 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4625
Mailing Address - Country:US
Mailing Address - Phone:586-979-7502
Mailing Address - Fax:586-979-3333
Practice Address - Street 1:39601 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4625
Practice Address - Country:US
Practice Address - Phone:586-979-7502
Practice Address - Fax:586-979-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0330700001OtherDME PECAN
MI5505022OtherPECAN
MI0330700001Medicare NSC