Provider Demographics
NPI:1255435350
Name:SUCCAR, BASHAR (MD)
Entity type:Individual
Prefix:
First Name:BASHAR
Middle Name:
Last Name:SUCCAR
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 1:44200 WOODWARD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-9490
Mailing Address - Country:US
Mailing Address - Phone:248-334-9490
Mailing Address - Fax:248-636-1170
Practice Address - Street 1:44200 WOODWARD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-9490
Practice Address - Country:US
Practice Address - Phone:248-334-9490
Practice Address - Fax:248-636-1170
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301035458207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB45382Medicare UPIN
MIOM90080Medicare ID - Type UnspecifiedMEDICARE