1457381543 NPI number — DR. BASHAR KIAMI M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457381543 NPI number — DR. BASHAR KIAMI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIAMI
Provider First Name:
BASHAR
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457381543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 MEADOWS
Provider Second Line Business Mailing Address:
GRAYLING
Provider Business Mailing Address City Name:
GRAYLING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49738-7131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
989-745-6601
Provider Business Mailing Address Fax Number:
989-745-6605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 MEADOWS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAYLING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49738-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-745-6601
Provider Business Practice Location Address Fax Number:
989-745-6605
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  4301063746 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 4301063746 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4174554 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4578241 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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