Provider Demographics
NPI:1700863313
Name:BASCH, DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BASCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:BASCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:43330 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-2022
Mailing Address - Country:US
Mailing Address - Phone:586-979-7502
Mailing Address - Fax:586-979-3333
Practice Address - Street 1:43330 MOUND RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-2022
Practice Address - Country:US
Practice Address - Phone:586-979-7502
Practice Address - Fax:586-979-3333
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDB001048213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1552288Medicaid
MI1626739Medicaid
MI1552288Medicaid
MI1626739Medicaid