Provider Demographics
NPI:1962670695
Name:BASHAR I. NAKHLEH, MD, PLC
Entity Type:Organization
Organization Name:BASHAR I. NAKHLEH, MD, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BASHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NAKHLEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-985-6777
Mailing Address - Street 1:1216 RICHARDSON ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-3549
Mailing Address - Country:US
Mailing Address - Phone:810-985-6777
Mailing Address - Fax:810-985-3025
Practice Address - Street 1:1216 RICHARDSON ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3549
Practice Address - Country:US
Practice Address - Phone:810-985-6777
Practice Address - Fax:810-985-3025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0P55730Medicare PIN
0N96280Medicare PIN