Provider Demographics
NPI:1740315670
Name:BASHEERA, HASAN (MD)
Entity type:Individual
Prefix:
First Name:HASAN
Middle Name:
Last Name:BASHEERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 US HIGHWAY 23 N
Mailing Address - Street 2:P.O. BOX 857
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-8018
Mailing Address - Country:US
Mailing Address - Phone:989-356-4049
Mailing Address - Fax:989-358-3712
Practice Address - Street 1:1185 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-8018
Practice Address - Country:US
Practice Address - Phone:989-356-4049
Practice Address - Fax:989-358-3712
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301093302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740315670Medicaid
MIZ16001059Medicare PIN