Provider Demographics
NPI:1720391113
Name:TAHA, BASEL (MD)
Entity Type:Individual
Prefix:
First Name:BASEL
Middle Name:
Last Name:TAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 W AUBURN RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-3865
Mailing Address - Country:US
Mailing Address - Phone:248-290-3111
Mailing Address - Fax:248-290-3100
Practice Address - Street 1:1886 W AUBURN RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3865
Practice Address - Country:US
Practice Address - Phone:248-290-3111
Practice Address - Fax:248-290-3100
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096452207RN0300X
MI4301086452390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program