Provider Demographics
NPI:1770693798
Name:BASHA DIAGNOSTICS P C
Entity type:Organization
Organization Name:BASHA DIAGNOSTICS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSSABASHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-435-8066
Mailing Address - Street 1:30701 WOODWARD AVE
Mailing Address - Street 2:SUITE# LL
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0987
Mailing Address - Country:US
Mailing Address - Phone:606-260-4144
Mailing Address - Fax:606-862-7605
Practice Address - Street 1:30701 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-0987
Practice Address - Country:US
Practice Address - Phone:248-288-1600
Practice Address - Fax:248-288-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37190Medicare PIN