Provider Demographics
NPI:1972244671
Name:MADANI, BASIL
Entity Type:Individual
Prefix:
First Name:BASIL
Middle Name:
Last Name:MADANI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11765 E ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-4968
Mailing Address - Country:US
Mailing Address - Phone:720-518-5231
Mailing Address - Fax:
Practice Address - Street 1:11765 E ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4968
Practice Address - Country:US
Practice Address - Phone:720-518-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver