Provider Demographics
NPI:1831298934
Name:BASHAR SUCCAR MD PC
Entity Type:Organization
Organization Name:BASHAR SUCCAR MD PC
Other - Org Name:BLOOMFIELD HEARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SUCCAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-334-9490
Mailing Address - Street 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5031
Mailing Address - Country:US
Mailing Address - Phone:248-334-9490
Mailing Address - Fax:248-636-1170
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5031
Practice Address - Country:US
Practice Address - Phone:248-334-9490
Practice Address - Fax:248-636-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI640F339780OtherBLUE CROSS BLUE SHIELD
MI640F337070OtherBLUE CROSS BLUE SHIELD
MI54OF322840OtherBLUE CROSS BLUE SHIELD