Provider Demographics
NPI:1396162814
Name:KAAKI, BASIL
Entity type:Individual
Prefix:
First Name:BASIL
Middle Name:
Last Name:KAAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9214 ANGELAS MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2155
Mailing Address - Country:US
Mailing Address - Phone:254-644-5101
Mailing Address - Fax:
Practice Address - Street 1:9214 ANGELAS MEADOW LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2155
Practice Address - Country:US
Practice Address - Phone:254-644-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant