Provider Demographics
NPI:1255396610
Name:BASHEER-GOWI, YASIER A (MD)
Entity type:Individual
Prefix:
First Name:YASIER
Middle Name:A
Last Name:BASHEER-GOWI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950245
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0245
Mailing Address - Country:US
Mailing Address - Phone:502-969-6552
Mailing Address - Fax:502-969-3799
Practice Address - Street 1:200 HIGH RISE DR
Practice Address - Street 2:STE 374
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3252
Practice Address - Country:US
Practice Address - Phone:502-969-6552
Practice Address - Fax:502-969-3799
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063087A207Q00000X
KY40703207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1223787OtherCHA / NICC
IN200855320Medicaid
KYP00305247OtherRRMCR / NICC
000000381983OtherANTHEM / NICC
104133OtherSIHO / NICC
KY6412077700Medicaid
104133OtherSIHO / NICC
KYP00305247OtherRRMCR / NICC
IN219370HMedicare PIN
000000381983OtherANTHEM / NICC