Provider Demographics
NPI:1881620581
Name:BASATNEH, LUTFI (MD)
Entity type:Individual
Prefix:DR
First Name:LUTFI
Middle Name:
Last Name:BASATNEH
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 1:1320 N GALLOWAY 101
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-2440
Mailing Address - Country:US
Mailing Address - Phone:972-342-6265
Mailing Address - Fax:972-279-9040
Practice Address - Street 1:1320 N GALLOWAY 101
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-2440
Practice Address - Country:US
Practice Address - Phone:972-342-6265
Practice Address - Fax:972-279-9040
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3984174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0966798-01Medicaid
TXF99349Medicare UPIN
TX8F4262Medicare PIN
TX0966798-01Medicaid