Provider Demographics
NPI:1942733944
Name:MASKONI, BASHAR (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:MASKONI
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44405 WOODWARD AVE
Mailing Address - Street 2:MEDICAL EDUCATION, H-23
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2985
Mailing Address - Country:US
Mailing Address - Phone:248-358-6233
Mailing Address - Fax:248-858-3244
Practice Address - Street 1:44405 WOODWARD AVE
Practice Address - Street 2:MEDICAL EDUCATION, H-23
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2985
Practice Address - Country:US
Practice Address - Phone:248-358-6233
Practice Address - Fax:248-858-3244
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2017-12-07
Deactivation Date:2017-11-09
Deactivation Code:
Reactivation Date:2017-12-07
Provider Licenses
StateLicense IDTaxonomies
MI4301112291207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine