Provider Demographics
NPI:1750603510
Name:B BASKOT MD PA
Entity type:Organization
Organization Name:B BASKOT MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BILJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASKOT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-888-9858
Mailing Address - Street 1:1142 E BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2012
Mailing Address - Country:US
Mailing Address - Phone:954-888-9858
Mailing Address - Fax:954-832-8385
Practice Address - Street 1:1142 E BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2012
Practice Address - Country:US
Practice Address - Phone:954-888-9858
Practice Address - Fax:954-832-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70813261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG30277Medicare UPIN