Provider Demographics
NPI:1720081631
Name:BASIT, ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:BASIT
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 1:4400 HERITAGE TRACE PKWY STE 208
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-8902
Mailing Address - Country:US
Mailing Address - Phone:817-518-9005
Mailing Address - Fax:817-518-9015
Practice Address - Street 1:4400 HERITAGE TRACE PKWY STE 208
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-8902
Practice Address - Country:US
Practice Address - Phone:817-518-9005
Practice Address - Fax:817-518-9015
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0409207RC0000X
OH82364207R00000X
ORMD24478207R00000X
IN01074641A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP02674505OtherMEDICARE RR
TX1720081631Medicaid
TX8SQ844OtherBCBS-TX
IN184520025Medicare UPIN