Provider Demographics
NPI:1710269584
Name:MARCOS, BASEM S (MD)
Entity Type:Individual
Prefix:
First Name:BASEM
Middle Name:S
Last Name:MARCOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BASEM
Other - Middle Name:SAMIR BESHARA
Other - Last Name:MARCOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:763-581-3700
Practice Address - Fax:763-581-3701
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI571792086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care