Provider Demographics
NPI:1649733809
Name:RAFIQ, BASIL
Entity type:Individual
Prefix:
First Name:BASIL
Middle Name:
Last Name:RAFIQ
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 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6211
Mailing Address - Fax:
Practice Address - Street 1:42550 GARFIELD RD STE 103
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-1644
Practice Address - Country:US
Practice Address - Phone:586-263-4411
Practice Address - Fax:586-286-1142
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901400462213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1730151036OtherTHOMAS C HOSEY DPM & ASSOCIATES
MI200826048OtherTHOMAS C HOSEY DPM & ASSOCIATES