Provider Demographics
NPI:1780613604
Name:BASSILI, LISA MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELLE
Last Name:BASSILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:BASSILI
Other - Last Name:AKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 35147
Mailing Address - Street 2:#1801
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5147
Mailing Address - Country:US
Mailing Address - Phone:503-299-9906
Mailing Address - Fax:503-225-9002
Practice Address - Street 1:707 SW WASHINGTON ST
Practice Address - Street 2:SUITE 700
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3536
Practice Address - Country:US
Practice Address - Phone:503-299-9990
Practice Address - Fax:503-225-9002
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35579207L00000X
TXM5045207L00000X
ORMD178245207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DR091OtherBCBS OF TEXAS
OR500717456Medicaid
TX8K4383Medicare PIN
TX324636YMERMedicare PIN
ORR191173Medicare PIN