Provider Demographics
NPI:1649200627
Name:QALIEH, BASHAR SHABB (MD)
Entity type:Individual
Prefix:
First Name:BASHAR
Middle Name:SHABB
Last Name:QALIEH
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 1:8550 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4352
Mailing Address - Country:US
Mailing Address - Phone:810-220-3700
Mailing Address - Fax:810-220-1321
Practice Address - Street 1:8550 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4352
Practice Address - Country:US
Practice Address - Phone:810-220-3700
Practice Address - Fax:810-220-1321
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061323208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBQ061323OtherBCBS OF MICHIGAN
MI4929561Medicaid
MIG16689Medicare UPIN
MIN3015005Medicare PIN