Provider Demographics
NPI:1710766050
Name:DARWISH, BASSAM A
Entity Type:Individual
Prefix:
First Name:BASSAM
Middle Name:A
Last Name:DARWISH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 STEADMAN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1755
Mailing Address - Country:US
Mailing Address - Phone:313-918-4429
Mailing Address - Fax:
Practice Address - Street 1:6800 STEADMAN ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1755
Practice Address - Country:US
Practice Address - Phone:313-918-4429
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide