Provider Demographics
NPI:1457381543
Name:KIAMI, BASHAR (MD)
Entity Type:Individual
Prefix:DR
First Name:BASHAR
Middle Name:
Last Name:KIAMI
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 1:201 MEADOWS
Mailing Address - Street 2:GRAYLING
Mailing Address - City:GRAYLING
Mailing Address - State:MI
Mailing Address - Zip Code:49738-7131
Mailing Address - Country:US
Mailing Address - Phone:989-745-6601
Mailing Address - Fax:989-745-6605
Practice Address - Street 1:201 MEADOWS DR
Practice Address - Street 2:
Practice Address - City:GRAYLING
Practice Address - State:MI
Practice Address - Zip Code:49738-2014
Practice Address - Country:US
Practice Address - Phone:989-745-6601
Practice Address - Fax:989-745-6605
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301063746207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4174554Medicaid
MI4578241Medicaid
B06000046Medicare ID - Type UnspecifiedMEDICARE BILLING NUMBER
MI4578241Medicaid
MI4578241Medicaid