Provider Demographics
NPI:1942693098
Name:MOHAMMED, BASHA IMTIYAZ (MD)
Entity Type:Individual
Prefix:DR
First Name:BASHA
Middle Name:IMTIYAZ
Last Name:MOHAMMED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ABDUL
Other - Middle Name:
Other - Last Name:MAHMAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6644 E BAYWOOD AVE
Mailing Address - Street 2:BANNER BAYWOOD MEDICAL CENTER ATTN: HOSPITALISTS
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206
Mailing Address - Country:US
Mailing Address - Phone:480-321-3900
Mailing Address - Fax:480-321-3840
Practice Address - Street 1:6644 E BAYWOOD AVE
Practice Address - Street 2:BANNER BAYWOOD MEDICAL CENTER ATTN: HOSPITALISTS
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206
Practice Address - Country:US
Practice Address - Phone:480-321-3800
Practice Address - Fax:480-321-3840
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA134707207R00000X
AZ50273208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine