Provider Demographics
NPI:1750781647
Name:HANOOSHI, BASHAR (MD)
Entity type:Individual
Prefix:
First Name:BASHAR
Middle Name:
Last Name:HANOOSHI
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 1:391 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-5271
Mailing Address - Country:US
Mailing Address - Phone:407-518-1074
Mailing Address - Fax:
Practice Address - Street 1:391 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5271
Practice Address - Country:US
Practice Address - Phone:407-518-1993
Practice Address - Fax:407-518-9056
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME135405207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program