Provider Demographics
NPI:1790889350
Name:BASCH, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:BASCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:41593 WINCHESTER RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-4858
Mailing Address - Country:US
Mailing Address - Phone:951-719-1111
Mailing Address - Fax:951-719-1122
Practice Address - Street 1:41593 WINCHESTER RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4858
Practice Address - Country:US
Practice Address - Phone:951-719-1111
Practice Address - Fax:951-719-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA015430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3408935Medicaid
CA201922288OtherTAX IDENTIFICATION NUMBER
CA3408935Medicaid