Provider Demographics
NPI:1669736153
Name:BASSILY, TIFFANY LYNN (DO)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:BASSILY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1435 N MILFORD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1015
Mailing Address - Country:US
Mailing Address - Phone:248-685-9780
Mailing Address - Fax:248-684-2251
Practice Address - Street 1:1435 N MILFORD RD STE 101
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1015
Practice Address - Country:US
Practice Address - Phone:248-685-9780
Practice Address - Fax:248-684-2251
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2020-05-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5315054297207R00000X
MI5101019713207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine